Research On Health Service Of Migrant Workers' Medical Insurance In Shenzhen

ObjectiveTo know health service need, demand and utilization of migrant workers and thehealth service supply, and the performance of the Migrant Worker's Medical InsuranceSystem (MWMIS) in Shenzhen, and to provide basis for related departments to perfectthe policy of medical insurance and design health service system for migrant workersby summarizing the experience and discovering problems.MethodsIn this study, document analysis, the field observation, depth interview, caseexample research, and comparison research were performed to investigate and analyzehealth service of MWMIS in Shenzhen. By combining quantity and quality analyses,efforts were afford to give a systematic review on the project from health servicedemander, provider and manager sides. In details, the health service supply, need,utilization rate and the influencing factors in migrant workers were analyzed by thedescriptive method and chi-square test. Multiple factor analysis such as linearregression was adopted to study satisfaction and the response of the migrant workers tothe community health service.ResultsThe study demonstrated that: (1) Health service supply of the migrant workers'medical insurance. There were 337 Community Health Centers (CHCs) totally.Average service radius and average service coverage of each CHC was 1.59 kilometersand 48.6 thousands people respectively. Totally the running condition of CHCs was bad,and 45.45％of them had a deficit; Among the migrant workers investigated, thosespending 10-19 min to walk to the nearest CHC accounted for 30.28％, and those spending 30 min or above for 37.32％; The constitution of the health human resourceswas not reasonable, and particularly there was a lack of the public health doctors. Thehealth human resources quantity of each CHC was 14. The ratio of doctors to nurseswas 1:0.76, which was higher than the whole nation's (1:0.61). Most professional titleswere junior, and the education background of the most migrant workers waspolytechnic.(2) Statue of migrant workers' health service need. The tow-week prevalence ratesof the insured and the un-insured were 22.24％and 25.52％, respectively, the chronicdisease prevalence rates of the insured and the un-insured were 21.06％and 16.68％,respectively, which were higher than the average levels in city areas in China in 2003(15.23％, and 17.73％, respectively).(3) Health service utilization of migrant workers. The two-week clinic rate of thesick insured and un-insured was 20.10％and 15.47％, respectively, and the two-weekno-clinic rate was 57.63％and 64.61％, respectively; The self-treatment percentage ofthe insured and the un-insured was 34.09％and 46.13％, respectively, and thepercentage of the insured and the un-insured who did not adopt any measure was23.54％and 20.07％, respectively. The major reasons of un-treatments included mildillness (more than 50.00％of patients) and economy difficulty (25.00％of patients).The clinic rate of the insured and the un-insured in CHCs was 42.44％, and 23.40％,respectively; The hospitalization rate of the insured and the un-insured was 3.56％and3.05％, which was both lower than that of the city population issued by the ThirdNational Health Service Investigation Report (4.2％); The hospitalization rate of theinsured and the un-insured in the township health centers was highest among the allmedical levels (42.86％, and 36.67％). The percentage of the insured and the un-insuredwho should stay in the hospital but did not stay in the hospital was 50.67％and 46.58％,respectively, and the major reason was economy difficulty, accounting for 74.36％and58.82％, respectively. There was no significant difference in the hospitalization rate andnot-hospitalization rate between the the insured and the un-insured (both P＞0.05). (4) Health service response of MWMI. Among the elements of the response, theaverage score of keeping secret was the highest (3.65), and those of environment andthe accessibility were the lowest (3.07). 12.31％of the patients believed the healthservice of MWMI was "very bad" or "bad", and 53.08％"good" or "very good". Broadlinear regression model indicated that professions and the proportion of the healthhuman resource with master degree and above could significantly influence theresponse (P＜0.05).(5) Health service satisfaction of MWMI. Among the factors, the average score ofthe satisfaction of service attitude was the highest (3.49), and that of the averageexpenses was the lowest (3.06). In overall evaluation of the satisfaction to medicalorganizations, 13.07％of the 399 patients were "very dissatisfied" or "not too satisfied".Broad linear regression model indicated that the medical expense every year, and theproportion of the health human resource with master degree and above couldsignificantly influence the health service satisfaction (P＜0.05).ConclusionsThere are some achievements in health service of MWMIS: The health humanresource has already been put in place; Reasonable allocation of seeking medical adviseof migrant workers has been taken shape; The medical expenses of the insured migrantworkers have been controlled certainly; The level of health service utilization has beenraising; The space of the CHCs was broaden, such as the service quantity and itemshave been increasing and the level of the health service accessibility has been improved;The response and satisfaction of migrant workers to health service were good.There are some problems: The quantity of health provider including theinstitutions and the staff were inadequate. The personnel components and the allocationof institution were not reasonable. The service level and quality should be improved.Induced medical service still existed; The health service needs of in-patient andout-patient were much, while the health service utilization of hospital was little; Policyshould be adopted to the health service of MWMIS; About half of the CHCs were deficit; (5) The dynamics of broadcasting medical insurance policy publicly was notenough to influence the migrant workers to attend in health service of MWMIS.Policy Suggestions(1) We should recognize MWMIS rightly and definite that the dominant functionof government in MWMIS clearly; (2) We should increase the ability of the healthservice supply to increase the utilization level of health service continuously; (3) Weshould increase the service level and quality of health insurance institution byincreasing the efficacy of the health insurance cards dealing, simplifying the procedureof submitting the expense account and turning to next health institution, increasing themanagement level of the medical institution, and enhancing the management level ofmigrant workers' medical insurance fund; (5) We should make a joint between thehealth service of MWMI and the New Cooperative Medical Insurance System(NCMIS); (6) The big disease medical relief system should be established to poormigrant workers. All of above will guarantee MWMI to develop continuously, stablyand healthily.Innovation(1) The research about MWMI system and its practice were first done by a widemargin in Shenzhen.(2) Under the proper level of raising insurance premium, we explore the supply,need and utilization of the health service of MWMI, and evaluate the quality of thehealth service.(3) The idea of combining MWMI system and community health service offered agood solution to guarantee the fairness among migrant workers.