Research article

Child health insurance coverage: a survey among temporary and permanent residents in Shanghai

Mingshan Lu¹ , Jing Zhang² , Jin Ma² , Bing Li³ and Hude Quan⁴

¹Department of Economics, University of Calgary, Calgary, Alberta, Canada

²School of Public Health, Shanghai Jiaotong University, Shanghai, PR China

³Calgary Health Region, Calgary, Alberta, Canada

⁴Department of Community Health Sciences and Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada

author email corresponding author email

BMC Health Services Research 2008, 8:238doi:10.1186/1472-6963-8-238

Published:	17 November 2008

Abstract

Background

Under the current healthcare system in China, there is no government-sponsored health insurance program for children. Children from families who move from rural and interior regions to large urban centres without a valid residency permit might be at higher risk of being uninsured due to their low socioeconomic status. We conducted a survey in Shanghai to describe children's health insurance coverage according to their migration status.

Method

Between 2005 and 2006, we conducted an in-person health survey of the adult care-givers of children aged 7 and under, residing in five districts of Shanghai. We compared uninsurance rates between temporary and permanent child residents, and investigated factors associated with child health uninsurance.

Results

Even though cooperative insurance eligibility has been extended to temporary residents of Shanghai, the uninsurance rate was significantly higher among temporary (65.6%) than permanent child residents (21.1%, adjusted odds ratio (OR): 5.85, 95% confidence interval (95% CI): 4.62–7.41). For both groups, family income was associated with having child health insurance; children in lower income families were more likely to be uninsured (OR: 1.96, 95% CI: 1.40–2.96).

Conclusion

Children must rely on their parents to make the insurance purchase decision, which is constrained by their income and the perceived benefits of the insurance program. Children from migrant families are at even higher risk for uninsurance due to their lower socioeconomic status. Government initiatives specifically targeting temporary residents and providing health insurance benefits for their children are urgently needed.