Are there tangible benefits for Chinese rural-suburban schoolchildren under cooperative health insurance schemes? Findings from a survey of schoolchildren

As China transforms its health insurance system towards voluntary use of cooperative schemes, developing effective and sustainable national/regional systems requires ongoing evaluation of existing programs. While a national Basic Health Insurance System is available for urban residents and a Rural Cooperative Medical System is piloted for peasants and their family, there is no national program for schoolchildren. Schoolchildren depend on commercial, or low premium, cooperative-like schemes such as Student Safety and Health Insurance and  Children’s Hospitalization Cooperative Foundation; many are left without a coverage altogether. At times of drastic transition, however, little is known about schoolchildren’s insurance status, much less their access and utilization of healthcare. In this study 623 households with a child attending elementary school were sampled from three rural/suburban townships to examine children’s insurance status, care access and utilization, and perception about the systems. Disparities between three groups were analyzed: families with child uninsured, insured under a cooperative-like scheme, or insured under a commercial scheme. Our findings indicate that (1) while coverage rate of peasants’ children is comparable to that of non-peasants, peasants’ children were more likely to enroll in low premium, cooperative-like schemes with limited benefits; (2) access to care was generally better among insured than uninsured, and parents of insured child were more satisfied with the current systems than those uninsured; but disparities between those under commercial and those under cooperative-like coverage were insignificant;  (3) among the three groups, differences in care affordability and utilization were marginal and insignificant, signaling the lack of tangible benefits to be delivered by insurance for children with routine needs.  Implications are of two-fold for cooperative schemes: protection against hazardous medical events attracts ordinary households; but innovation and re-structuring at regional level is needed in order to improve affordability and utilization, a prerequisite for system sustainability.