Coverage rate and impact factors of children’s medical insurance in Chongqing

Objective

To investigate the coverage rates and influencing factors of different types of medical insurance (MI) for children in current health insurance system framework of China and provide evidence for MI policies.

Methods

We conducted a cross-sectional study using data from Chongqing collected through a two-stage stratified cluster sampling method. The study population included 4705 children aged 9–13 years. Insurance status was categorized into three groups: dual coverage (both basic medical insurance (BMI) and commercial medical insurance (CMI), single coverage (either BMI or CMI), and no insurance coverage.

Results

Among participants, 28.25 % had dual insurance, 56.58 % had single MI, and 15.18 % were uninsured. Multivariate logistic regression analysis revealed that co-residence with parents, higher paternal education level, parents' marital status (intact or remarried), low academic pressure, secondhand smoke exposure, overweight status, and cesarean section birth were positively associated with medicine insurance coverage. Conversely, introverted personality (OR=0.14, P < 0.001 for dual; OR=0.32, P < 0.001 for single coverage) and recent incidence of cold (OR=0.72, P = 0.009 for dual; OR=0.77, P = 0.021 for single coverage) showed negative associations with insurance coverage. Notably, children's extroversion and high family income were positively correlated with the dual insurance coverage. Younger children more likely to have single MI, but parents' high expectations showed a negative correlation.

Conclusion

The coverage rate of children's MI in Chongqing remains inadequate. It is advisable to implement targeted interventions for high-risk groups including children from low-income or single-parent families, those with underlying health issues, and left-behind children. These measures aim to reduce household financial burden and promote children's health equity.

Summary

Our research revealed that while 84.82 % of children had some form of medical insurance, with 56.58 % having single coverage and 15.18 % remaining uninsured. The coverage of various types of insurance for children in Chongqing is currently inadequate. Our study underscores the complex interplay between health behaviors, healthcare utilization, and insurance decisions. The government should prioritize understanding the factors that influence children's participation in insurance programs and enhance support for children's medical insurance.