title: Child health security in China: a survey of child health insurance coverage in diverse areas of the country.
abstract: China embarked on an ambitious health system reform in 2009, and pledged to achieve universal health insurance coverage by 2020. However, there are gaps in access to healthcare for some children in China. We assessed health insurance status and associated variables among children under five in twelve communities in 2010: two urban community health centers and two rural township health centers in each of three municipalities located in China's distinctly different East, Central and Western regions. Information on demographic and socio-economic variables and children's insurance status was gathered from parents or caregivers of all children enrolled in local health programs, and others recruited from the local communities. Only 62% of 1131 children assessed were insured. This figure did not vary across geographic regions, but urban children were less likely to be insured than rural children. In multivariate analysis, infants were 2.44 times more likely to be uninsured than older children and children having at least one migrant parent were 1.90 times more likely to be uninsured than those living with non-migrant parents. Low maternal education was also associated with being uninsured. Gaps in China's child health insurance coverage might be bridged if newborns are automatically covered from birth, and if insurance is extended to all urban migrant children, regardless of the family's residential registration status and size.
authors.affiliation: The School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of General Medicine, Columbia University Medical Center, New York, USA.
authors.forename: Juyang
authors.initials: J
authors.lastname: Xiong
authors.forename: David
authors.initials: D
authors.lastname: Hipgrave
authors.forename: Karoline
authors.initials: K
authors.lastname: Myklebust
authors.forename: Sufang
authors.initials: S
authors.lastname: Guo
authors.forename: Robert W
authors.initials: RW
authors.lastname: Scherpbier
authors.forename: Xuetao
authors.initials: X
authors.lastname: Tong
authors.forename: Lan
authors.initials: L
authors.lastname: Yao
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
mesh_terms: D000367:Age Factors; D002669:Child Welfare; D002675:Child, Preschool; D002681:China; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Children; China; Coverage; Health insurance; Infants