Background As China re-establishes its health insurance system through various cooperative schemes, little is known about schoolchildren’s health insurance. children’s access to and affordability of Evofosfamide healthcare, their healthcare-seeking behaviors, and overall satisfaction with healthcare, but had little impact on utilization of outpatient care. Conclusion Enrolling and retaining schoolchildren in health insurance are threatened by the limited tangible value for routine care and low reimbursement rate for major medical events under the low-premium cooperative schemes. Coverage rates may be improved by offering complimentary and supplementary benefit options with flexible premiums via a multi-tier system consisting of national, regional, and commercial programs. Health insurance education by means of community outreach can reinforce positive parental perceptions, hence promoting and retaining insurance enrollment in short-term. Background By the 1970s, nearly all urban Chinese population and 85% rural residents were covered under a health insurance scheme[1]. Market-oriented reform in the following decades witnessed the disintegration of the healthcare system and the disappearance of the public insurance systems[2]. By 2003, insurance coverage fell to 54C55% in urban population with only 12% of the poorest fifth covered[3,4], while 79% (640 million) rural residents were without insurance due to the dissolution of agricultural communes that had served as the primary payer[2,3,5]. In the meantime, out-of-pocket medical costs climbed steadily[2,6], healthcare utilization declined[3], and barriers to healthcare rose, particularly for the poor and the rural [7,8]. In 1998 the Chinese government began to establish a basic health insurance scheme Evofosfamide (BHIS) for registered urban workers and retirees[9]. The cooperative BHIS does not, however, cover children or other dependents[9,10]. In 1994 the government began to pilot a new rural cooperative medical system (RCMS) in rural areas[11], expanding the program to 310 counties by 2004[5,12] and aiming to cover the entire rural population by 2010. Only farmers are eligible for RCMS and enrollment is voluntary in unit of a household. As of 2006, households, local, and central governments each contributed no less than 20 yuan (RMB) per enrollee[13]. Amid these fundamental reforms, health insurance access and coverage of schoolchildren is largely unknown[8]. Except for a few earlier studies on children’s health insurance coverage using data from the China Health and Nutrition Survey prior to 1997[6,8], studies on healthcare access, outcomes, and disparities between urban and rural Evofosfamide populations generally have not examined children [14-16]. For instance, the 2003 Third National Evofosfamide Health Services Survey (NHSS) remained non-specific to the country’s 270 million children[3]; another study by Xu et al [4] only considered age-group insurance coverage for urban population based on Rabbit Polyclonal to OR8J3 the 2003 NHSS data. As China adopts national and regional cooperative schemes to re-establish a national health insurance system, achieving and sustaining a high enrollment rate are a benchmark for program success. It is thus critical to identify barriers to enrollment, uncover disparities among rural and urban populations, and evaluate perceived and tangible benefits of existing cooperative schemes. Based on a survey of elementary schoolchildren, this paper focuses on disparate health insurance coverage among farmers’ Evofosfamide and non-farmers’ children, along with their access to and utilization of healthcare under various insurance schemes. It also discusses potential threats to sustainable insurance enrollment, and recommends measures for program improvement. Methods Study Setting Pinggu is a mountainous district in eastern Beijing; over 75% of its 397,000 residents are farmers and 60% of land area agricultural. The area represents a growing segment of rural China that is in close proximity to major cities and is undergoing rapid socioeconomic transition. The BHIS was established there in 2001 and the RCMS in 2004. Beginning in the 1990s, a Student Safety and Health Insurance (SSHI) program was introduced through local school administrations in partnership with commercial vendors. The SSHI charges an annual premium of 60 to a hundred some yuan (RMB), reimburses partially medical expenses incurring from major events such as surgery and hospitalization. In September 2004, the local Red Cross, municipal Education Commission, and Bureau of Hygiene and Health jointly established.