Medical insurance coverage and its associated factors among children in urban and rural Chongqing, China

Background: Children face a heavy disease burden, while healthcare utilization remains low. This study seeks to assess the proportions of children in Chongqing covered by medical insurance and identify associated factors. Methods: From March to June 2019, a stratified cluster sampling was employed to cover 4705 participants in Chongqing's urban and rural districts. In a cross-sectional survey, univariate and multivariate mixed logistic regression analysis were performed to explore the determinants of medical insurance enrolment. Results The participation rates of basic medical insurance (BMI) were 83.29%, 85.29% and 81.11% in total, urban areas and rural areas, respectively. For commercial medical insurance (CMI), the corresponding rates were 29.78%, 34.95% and 24.11%, respectively. After adjusting for covariates, younger child age, better quality of life and higher annual household income were associated with a higher BMI participation rate. Conversely, children with asthma had lower odds of BMI coverage. For CMI, childhood obesity was a risk factor for being uninsured, while higher parental education, rhinitis, annual family income >150 000 RMB, caesarean section history and maternal gestational diabetes significantly increased the likelihood of CMI enrolment. Conclusions: In summary, universal health insurance coverage for children in Chongqing remains unfulfilled. To ameliorate the gaps and inequalities in children's insurance, sustained efforts are necessary, including improving household economic conditions, enhancing parental education levels and focusing on children's physical health. Therefore, policy supports should be enhanced, especially for economically disadvantaged rural areas in southwestern China.