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Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China.

Qiu P, Yang Y, Zhang J, Ma X - BMC Public Health (2011)

Bottom Line: Migration was positively associated with improved household economic status.However, obtaining reimbursement under the current NCMS for the cost of hospital services provided by undesignated providers in urban centers is limited.Addressing this challenge is an emerging policy priority.

View Article: PubMed Central - HTML - PubMed

Affiliation: West China School of Public Health, Sichuan University, No, 17, Section 3, South Renmin Road, Chengdu, Sichuan, China.

ABSTRACT

Background: China has been experiencing the largest rural to urban migration in history. Rural-to-urban migrants are those who leave their hometown for another place in order to work or live without changing their hukou status, which is a household registration system in China, categorizing people as either rural residents or urban residents. Rural-to-urban migrants typically find better job opportunities in destination cities, and these pay higher salaries than available in their home regions. This has served to improve the enrollment rates in the New Cooperative Medical Scheme (NCMS) of rural families, protecting households from falling into poverty due to diseases. However, current regulations stipulate that people who are registered in China's rural hukou can only participate in their local NCMS, which in turn poses barriers when migrants seek medical services in the health facilities of their destination cities. To examine this issue in greater depth, this study examined the associations between migration, economic status of rural households, and NCMS enrollment rate, as well as NCMS utilization of rural-to-urban migrants.

Methods: A multistage cluster sampling procedure was adopted. Our sample included 9,097 households and 36,720 individuals. Chi-square test and T-test were used to examine differences between the two populations of migrants and non-migrants based on age, gender, marriage status, and highest level of education. Ordinal logistic regression was used to examine the association between migration and household economic status. Binary logistic regression was used to examine the associations between household economic status, migration and enrollment in the NCMS.

Results: Migration was positively associated with improved household economic status. In households with no migrants, only 11.3% of the population was in the richest quintile, whereas the percentage was more than doubled in households with family members who migrated in 2006. Among those using in-patient medical services, 54.3% of migrants in comparison with 17.5% of non-migrants used out-of-county hospitals, many of which were not designated hospitals (Designated hospitals refer to hospitals where, if people use in patient health care, could receive reimbursement from the NCMS.); and 55.2% of migrants in comparison with 24.6% of non-migrants, who had the NCMS in 2006, received no reimbursement from the NCMS. The three main reasons of not receiving reimbursement were: staying in a hospital not designated by the NCMS, lack of knowledge of NCMS policies, and encountering difficulties obtaining reimbursement.

Conclusion: Migrants to urban centers improve the economic status of their rural household economic of origin. However, obtaining reimbursement under the current NCMS for the cost of hospital services provided by undesignated providers in urban centers is limited. Addressing this challenge is an emerging policy priority.

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Related in: MedlinePlus

The distribution of household economic status by county. An asset index was constructed by using principal component analysis (PCA) to classify household economic status. Eleven variables from Section A of the questionnaire were used to calculate the PCA (Appendix A). The first principal component (eigenvalue: 3.315, account for 30.14%) was used to quintile the household economic status (Appendix B). As a result, each household was assigned into one of the five quintiles.
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Figure 1: The distribution of household economic status by county. An asset index was constructed by using principal component analysis (PCA) to classify household economic status. Eleven variables from Section A of the questionnaire were used to calculate the PCA (Appendix A). The first principal component (eigenvalue: 3.315, account for 30.14%) was used to quintile the household economic status (Appendix B). As a result, each household was assigned into one of the five quintiles.

Mentions: Thus, an asset-based index was introduced and developed as an alternative tool for classifying household economic status [21-24]. Considering that rural people in China usually have household products, which are very difficult to monetize, we constructed an asset index by using principal component analysis (PCA). Eleven variables from Section A of the questionnaire were used to calculate the PCA (Appendix A). The first principal component (eigenvalue: 3.315, account for 30.14%) was used to quintile the household economic status (Appendix B). As a result, each household was assigned into one of the five quintiles (Figure 1).


Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China.

Qiu P, Yang Y, Zhang J, Ma X - BMC Public Health (2011)

The distribution of household economic status by county. An asset index was constructed by using principal component analysis (PCA) to classify household economic status. Eleven variables from Section A of the questionnaire were used to calculate the PCA (Appendix A). The first principal component (eigenvalue: 3.315, account for 30.14%) was used to quintile the household economic status (Appendix B). As a result, each household was assigned into one of the five quintiles.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3142513&req=5

Figure 1: The distribution of household economic status by county. An asset index was constructed by using principal component analysis (PCA) to classify household economic status. Eleven variables from Section A of the questionnaire were used to calculate the PCA (Appendix A). The first principal component (eigenvalue: 3.315, account for 30.14%) was used to quintile the household economic status (Appendix B). As a result, each household was assigned into one of the five quintiles.
Mentions: Thus, an asset-based index was introduced and developed as an alternative tool for classifying household economic status [21-24]. Considering that rural people in China usually have household products, which are very difficult to monetize, we constructed an asset index by using principal component analysis (PCA). Eleven variables from Section A of the questionnaire were used to calculate the PCA (Appendix A). The first principal component (eigenvalue: 3.315, account for 30.14%) was used to quintile the household economic status (Appendix B). As a result, each household was assigned into one of the five quintiles (Figure 1).

Bottom Line: Migration was positively associated with improved household economic status.However, obtaining reimbursement under the current NCMS for the cost of hospital services provided by undesignated providers in urban centers is limited.Addressing this challenge is an emerging policy priority.

View Article: PubMed Central - HTML - PubMed

Affiliation: West China School of Public Health, Sichuan University, No, 17, Section 3, South Renmin Road, Chengdu, Sichuan, China.

ABSTRACT

Background: China has been experiencing the largest rural to urban migration in history. Rural-to-urban migrants are those who leave their hometown for another place in order to work or live without changing their hukou status, which is a household registration system in China, categorizing people as either rural residents or urban residents. Rural-to-urban migrants typically find better job opportunities in destination cities, and these pay higher salaries than available in their home regions. This has served to improve the enrollment rates in the New Cooperative Medical Scheme (NCMS) of rural families, protecting households from falling into poverty due to diseases. However, current regulations stipulate that people who are registered in China's rural hukou can only participate in their local NCMS, which in turn poses barriers when migrants seek medical services in the health facilities of their destination cities. To examine this issue in greater depth, this study examined the associations between migration, economic status of rural households, and NCMS enrollment rate, as well as NCMS utilization of rural-to-urban migrants.

Methods: A multistage cluster sampling procedure was adopted. Our sample included 9,097 households and 36,720 individuals. Chi-square test and T-test were used to examine differences between the two populations of migrants and non-migrants based on age, gender, marriage status, and highest level of education. Ordinal logistic regression was used to examine the association between migration and household economic status. Binary logistic regression was used to examine the associations between household economic status, migration and enrollment in the NCMS.

Results: Migration was positively associated with improved household economic status. In households with no migrants, only 11.3% of the population was in the richest quintile, whereas the percentage was more than doubled in households with family members who migrated in 2006. Among those using in-patient medical services, 54.3% of migrants in comparison with 17.5% of non-migrants used out-of-county hospitals, many of which were not designated hospitals (Designated hospitals refer to hospitals where, if people use in patient health care, could receive reimbursement from the NCMS.); and 55.2% of migrants in comparison with 24.6% of non-migrants, who had the NCMS in 2006, received no reimbursement from the NCMS. The three main reasons of not receiving reimbursement were: staying in a hospital not designated by the NCMS, lack of knowledge of NCMS policies, and encountering difficulties obtaining reimbursement.

Conclusion: Migrants to urban centers improve the economic status of their rural household economic of origin. However, obtaining reimbursement under the current NCMS for the cost of hospital services provided by undesignated providers in urban centers is limited. Addressing this challenge is an emerging policy priority.

Show MeSH
Related in: MedlinePlus