Educational Disparities in Access to Health Insurance in China, 1989–2009

Abstract

Using data from the China Health and Nutrition Survey, we examine changes in educational differentials in access to health insurance over the period 1989–2009. Our analysis yielded three notable results. Firstly, regardless of level of education, the overall health insurance access rate exhibited a U-shaped change during the study period and the majority of people have been covered by health insurance by 2009. Secondly, the better educated enjoyed the advantage in receiving health insurance, particularly for employment-based insurance. Thirdly, educational disparity in access to health insurance changed over time. Specifically, the influence of education on overall access to insurance has been in decline during the two decades studied, indicating a convergence of access to health insurance across education levels. In contrast, employment-based insurance has converged across education level in the earlier years but diverged in more recent years over our study period. We argue that these patterns should be understood in the context of market reforms and changes of state-welfare provision over time.

Acknowledgements

We are grateful to Lei Jin, Yu Xie, and three anonymous reviewers for their comments and suggestions. The ideas expressed herein are those of the authors.

Notes

Liaoning dropped out of the survey in 1997 and was replaced by Heilongjiang; Liaoning has returned to the survey since 2000.

China has seen a great educational expansion in the recent decades (Treiman 2013). We test for the importance of such compositional changes by dividing the sample of each wave into education terciles. We find that the use of the relative measure of education does not greatly alter the main substantive results.

Additional information

Notes on contributors

Weixiang Luo

Weixiang Luo is assistant professor at the Institute of Population Research at Fudan University. His main research areas are social demography, health issues, social stratification, and China studies. His recent research examines the temporal-spatial variation in the education gradient of body weight among Chinese adults and how the variation is associated with levels of economic development.

Yuying Tong

Yuying Tong is associate professor of sociology at the Chinese University of Hong Kong. Her research areas cross social demography, migration and immigration, family and life course, gender disparity and quantitative methods. Her on-going projects include integration of immigrants/migrants in the host society, consequences of migration, family and life course, and labor market outcomes of highly skilled immigrants.