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Chinese residents’ educational disparity and social insurance coverage

Yen-Han Lee (Indiana University School of Public Health, Bloomington, Indiana, USA)
Timothy Chiang (Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA)
Mack Shelley (Iowa State University, Ames, Iowa, USA)
Ching-Ti Liu (Boston University School of Public Health, Boston, Massachusetts, USA)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 13 August 2018

264

Abstract

Purpose

The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China’s social health insurance scheme following the reform.

Design/methodology/approach

Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design (n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported.

Findings

The authors found that education is associated with all social health insurance schemes in China after the reform (p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44–8.13) or university and above (OR: 9.86, 95% CI: 8.14–11.96), are associated with UEBMI, compared with lower-educated individuals.

Practical implications

The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China’s universal health coverage and social disparity.

Originality/value

This study is the first to investigate the association between residents’ educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.

Keywords

Acknowledgements

The authors thank: Dr Frank Feeley, Associate Professor, Boston University School of Public Health, for his comments; National Institute for Nutrition and Health staff, China Center for Disease Control and Prevention; Carolina Population Center (P2C HD050924, T32 HD007168); University of North Carolina at Chapel Hill; NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700); NIH Fogarty International Center (D43 TW009077, D43 TW007709) for financial support for the CHNS data collection and analysis files from 1989 to 2015; China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009; Chinese National Human Genome Center at Shanghai since 2009; and the Beijing Municipal Center for Disease Prevention and Control since 2011.

Citation

Lee, Y.-H., Chiang, T., Shelley, M. and Liu, C.-T. (2018), "Chinese residents’ educational disparity and social insurance coverage", International Journal of Health Care Quality Assurance, Vol. 31 No. 7, pp. 746-756. https://doi.org/10.1108/IJHCQA-06-2017-0098

Publisher

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Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited

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