title: Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference?
abstract: BACKGROUND
  As one of the most populous metropolitan areas in the Pearl River Delta of South China, Shenzhen attracts millions of migrant workers annually. The objectives of this study were to compare health needs, self-reported health and healthcare utilisation of insured and uninsured migrant workers in Shenzhen, China, where a new health insurance scheme targeting at migrant workers was initiated.
  
  
  METHODS
  A cross-sectional survey using multi-staged sampling was conducted to collect data from migrant factory workers. Statistical tests included logistic regression analysis were used.
  
  
  RESULTS
  Among 4634 subjects (96.54%) who responded to the survey, 55.11% were uninsured. Disease patterns were similar irrespective of insurance status. The uninsured were more likely to be female, single, younger and less educated unskilled labourers with a lower monthly income compared with the insured. Out of 1136 who reported illness in the previous two weeks, 62.15% did not visit a doctor. Of the 296 who were referred for inpatient care, 48.65% did not attend because of inability to pay. Amongst those who reported sickness, 548 were insured and 588 were uninsured. Those that were insured, and had easier access to care were more likely to make doctor visits than those who were uninsured.
  
  
  CONCLUSIONS
  Health care utilisation patterns differ between insured and uninsured workers and insurance status appears to be a significant factor. The health insurance system is inequitably distributed amongst migrant workers. Younger less educated women who are paid less are more likely to be uninsured and therefore to pay out of pocket for their care. For greater equity this group need to be included in the insurance schemes as they develop.
authors.affiliation: Shenzhen Centre for Disease Control and Prevention, Shenzhen, 518020, Guangdong, China. moujin@gmail.com
authors.forename: Jin
authors.initials: J
authors.lastname: Mou
authors.forename: Jinquan
authors.initials: J
authors.lastname: Cheng
authors.forename: Dan
authors.initials: D
authors.lastname: Zhang
authors.forename: Hanping
authors.initials: H
authors.lastname: Jiang
authors.forename: Liangqiang
authors.initials: L
authors.lastname: Lin
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult