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

机译：从农村到城市的迁移及其对中国新型合作医疗计划覆盖和利用的启示

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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.
机译：背景信息中国一直在经历历史上最大的农村人口向城市人口迁移。城乡移民是指在不改变户口身份的情况下离开家乡到另一地方工作或居住的人。户口是中国的户口登记制度，将人们分为农村居民或城市居民。从农村到城市的移民通常会在目的地城市找到更好的工作机会，这些人支付的薪水比其本国地区高。这有助于提高农村家庭的新合作医疗计划（NCMS）的入学率，保护家庭避免因疾病而陷入贫困。但是，现行法规规定，在中国农村户口注册的人只能参加当地的新农合，这反过来给移民在目的地城市的医疗机构中寻求医疗服务构成障碍。为了更深入地研究这个问题，本研究研究了移民，农村家庭经济状况与新农合入学率以及从农村到城市移民的新农合利用之间的联系。方法采用多阶段整群抽样程序。我们的样本包括9,097户家庭和36,720个人。卡方检验和T检验用于根据年龄，性别，婚姻状况和最高学历来检查移民和非移民这两个人口之间的差异。使用序数逻辑回归检验移民与家庭经济状况之间的关系。二元逻辑回归用于检验家庭经济状况，迁徙与新农合入学之间的联系。结果移民与家庭经济状况改善呈正相关。在没有移民的家庭中，最富有的五分之一人口中只有11.3％，而在2006年有家庭成员移民的家庭中，这一百分比增加了一倍以上。在使用住院医疗服务的家庭中，相比而言，有54.3％的移民非移民医院中有17.5％的非移民使用了医院，其中许多不是指定医院（指定医院是指如果人们用于患者医疗，可以从新农合获得报销的医院）; 55.2％的移民与2006年患有新农合的非移民的24.6％相比，没有从新农合获得报销。无法获得报销的三个主要原因是：住在非新农合指定的医院，对新农合政策的了解不足以及难以获得报销。结论迁往城市中心的移民改善了其农村家庭经济来源的经济状况。但是，在当前的新农合下，无法获得城市中非指定医疗机构提供的医院服务费用的报销是有限的。应对这一挑战是新出现的政策重点。

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