Research

Health insurance of rural/township schoolchildren in Pinggu, Beijing: coverage rate, determinants, disparities, and sustainability

Jane M Zhu^1,2,3 , Yiliang Zhu⁴ and Rui Liu^5,6

¹  Harvard Medical School, 260 Longwood Ave, Rm. 233 Boston, MA 02115, USA

²  Sanford Institute of Public Policy, Duke University, P.O. Box 99712, Durham, NC 27708, USA

³  Formally: Fudan University School of Public Health, Shanghai, PR China

⁴  Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, Florida 33612-3805, USA

⁵  Health Services and Policy Analysis, 140 Warren Hall #7360, University of California-Berkeley, Berkeley, California 94720, USA

⁶  Formally: Beijing University Guanghua School of Management, Haidian District, Beijing, 100871, PR China

author email corresponding author email

International Journal for Equity in Health 2008, 7:23doi:10.1186/1475-9276-7-23

Published:	3 November 2008

Abstract

Background

As China re-establishes its health insurance system through various cooperative schemes, little is known about schoolchildren's health insurance. This paper reports findings from a study that examined schoolchildren's insurance coverage, disparities between farmer and non-farmer households, and effects of low-premium cooperative schemes on healthcare access and utilization. It also discusses barriers to sustainable enrollment and program growth.

Method

A survey of elementary school students was conducted in Pinggu, a rural/suburban district of Beijing. Statistical analyses of association and adjusted odds ratio via logistic regression were conducted to examine various aspects of health insurance.

Results

Children's health insurance coverage rose to 54% by 2005, the rates are comparable for farmers' and non-farmer's children. However, 76% of insured farmers' children were covered under a low-premium scheme protecting only major medical events, compared to 42% among insured non-farmers' children. The low-premium schemes improved parental perceptions of children's access to and affordability of healthcare, their healthcare-seeking behaviors, and overall satisfaction with healthcare, but had little impact on utilization of outpatient care.

Conclusion

Enrolling and retaining schoolchildren in health insurance are threatened by the limited tangible value for routine care and low reimbursement rate for major medical events under the low-premium cooperative schemes. Coverage rates may be improved by offering complimentary and supplementary benefit options with flexible premiums via a multi-tier system consisting of national, regional, and commercial programs. Health insurance education by means of community outreach can reinforce positive parental perceptions, hence promoting and retaining insurance enrollment in short-term.