title: Determinants of Health Insurance Coverage among People Aged 45 and over in China: Who Buys Public, Private and Multiple Insurance.
abstract: BACKGROUND
  China is reforming and restructuring its health insurance system to achieve the goal of universal coverage. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China.
  
  
  METHODS
  We used data from the China Health and Retirement Longitudinal Survey 2011 and 2013, a nationally representative survey of Chinese people aged 45 and over. Multinomial logit regression was performed to identify the determinants of public, private and multiple health insurance coverage. We also conducted logit regression to examine the association between public insurance coverage and demand for private insurance.
  
  
  RESULTS
  In 2013, 94.5% of this population had at least one type of public insurance, and 12.2% purchased private insurance. In general, we found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34-0.47) and were less likely to buy private insurance (RRR = 0.22, 95% CI: 0.16-0.31). But rural-to-urban migrants were more likely to be uninsured (RRR = 1.39, 95% CI: 1.24-1.57). Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48-0.63), particularly among enrollees of Urban Resident Basic Medical Insurance. There exists a huge socioeconomic disparity in both public and private insurance coverage.
  
  
  CONCLUSIONS
  The migrants, the poor and the vulnerable remained in the edge of the system. The growing private insurance market did not provide sufficient financial protection and did not cover the people with the greatest need. To achieve universal coverage and reduce socioeconomic disparity, China should integrate the urban and rural public insurance schemes across regions and remove the barriers for the middle-income and low-income to access private insurance.
authors: China Center for Health Development Studies, Peking University. 38 Xue Yuan Road, Haidian District, Beijing 100191, China.
authors: Yinzi
authors: Y
authors: Jin
authors: Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (Ministry of Health), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
authors: Zhiyuan
authors: Z
authors: Hou
authors: Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall, Athens, GA, United States of America.
authors: Donglan
authors: D
authors: Zhang
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty; D017149:Private Sector; D017150:Public Sector; D012044:Regression Analysis; D012179:Retirement; D012306:Risk; D012424:Rural Population; D012923:Social Class; D019472:Universal Health Insurance / Q000191:economics