ABSTRACT:
In China, Urban Employee Basic Medical Insurance (UEBMI) is a compulsory health coverage for people employed in urban areas and provides the best access to healthcare. Having UEBMI is thus crucial for rural-to-urban migrant workers, the lack thereof indicates informal employment and unequal healthcare access. This study aims to explore contributing factors to UEBMI coverage gaps between gender and ethnicity migrant worker subgroups. Using the population-based, nationally representative data from the China Migrant Dynamics Survey (2009 - 2018), we assessed the UEBMI coverage rate gaps in China’s migrant worker subgroups. Using probit regression models, we applied the Oaxaca-Blinder decomposition method to examine the extent to which gender and ethnicity disparities could be explained by socioeconomic gradients in UEBMI coverage rate status. 1 199 013 participants were included in our study, 46.9% (561 808) were women, 7.8% (93 934) were ethnic minority group, and average age was 34.6 (± 10.2) years. Women (16.67%, 95% CI [16.54 – 16.79]) showed higher UEBMI coverage than men (15.93%, 95% CI [15.83 – 16.03]), and ethnic minority showed lower coverage (12.09%, 95% CI [11.85 – 12.34]) than Han majority (16.59%, 95% CI [16.50 – 16.67]). Decomposition analysis indicated education (Bachelor's degree) was the major contributor to the UEBMI differences between gender and ethnicity groups. If the subgroups had equally Bachelor’s degree, the coverage gap would enlarge between sexes by 66.87%, but would be reduced between ethnicity groups by 17.57%. Age and occupation were main contributors in UEBMI differences between sexes; living in western region would close the UEBMI gap between ethnic minority and Han majority groups. Our study found differences in UEBMI coverage rate status between migrant worker subgroups. Our findings contribute to targeted policy strategies to enhance UEBMI coverage equality, to reduce healthcare access inequalities in migrant worker subgroups.