Health Insurance Schemes and Chronic Disease Management Behaviours in China: Evidence from Women with Non-Communicable Diseases.

Abstract

Background: Women in China bear a disproportionate burden of non-communicable diseases (NCDs), but limited evidence is available on whether different health insurance schemes are associated with chronic disease management behaviours.

Objective: To examine the association between insurance type and chronic disease management behaviors among insured Chinese women with NCDs.

Methods: We used data from a national cross-sectional online survey of approximately 7,000 women conducted in 31 provinces in China from 1 June to 20 August 2025 by the Institute for Health China Studies, Tsinghua University. Linear probability models with robust standard errors were used to estimate the associations between insurance type and three chronic disease management behaviours: medication adherence, lifestyle intervention, and health surveillance. Dietary regularity and health-product purchases were examined as spillover outcomes.

Results: Among survey respondents, 1,101 insured women aged 17-70 years reported at least one physician-diagnosed NCD. Compared with Urban Employee Basic Medical Insurance (UEBMI) enrollees, women covered by the government-funded medical subsidy program (GovMed) had a higher probability of medication adherence (β = 0.116, 95% CI: -0.003 to 0.236), whereas Urban-Rural Resident Basic Medical Insurance (URRMI) enrollees did not differ significantly (β = -0.026, 95% CI: -0.101 to 0.049). After adjustment, differences across schemes in lifestyle intervention and health surveillance were small and not statistically significant. Menopausal heterogeneity was concentrated in medication adherence: among post-menopausal women, GovMed enrollees had a 36.4-percentage-point higher probability of medication adherence than UEBMI enrollees (β = 0.364, 95% CI: 0.219 to 0.509). Supplementary commercial insurance was positively associated with health surveillance, but not with medication adherence or lifestyle intervention. Insurance-related differences in dietary regularity were weak and not statistically robust.

Conclusion: Insurance-related differences in chronic disease management among Chinese women with NCDs are most evident for medication adherence, particularly among post-menopausal women. Broader self-management behaviours appear less responsive to scheme differences.