Patterns of CPBMI-OC and associated factors among platform workers in new forms of employment in China: a...

Despite the basic medical insurance system achieving 95% coverage in China, platform workers in new forms of employment (PWNFEs) face significant challenges in maintaining continuous participation in basic medical insurance (CPBMI). This study aims to identify distinct patterns of CPBMI by occupational characteristics (CPBMI-OC) and their associated factors.

We conducted a cross-sectional survey with 641 PWNFEs in China using a structured questionnaire and employed latent class analysis (LCA) to identify patterns of CPBMI-OC. We utilized multinomial logistic regression to examine the associations between patterns of CPBMI-OC and variables, including demographics, socioeconomic status, medical service utilization, and health and insurance statuses.

Among the 641 PWNFEs surveyed (74.4% aged 20-39 years, 79.4% male), the basic medical insurance (BMI) coverage rate was 38.7%, with 85.6% of participants reporting interruptions. LCA identified three distinct patterns: (1) fully interrupted, high-income, family migration class (13.4%); (2) high interruption, mid-income, stable residence class (30.9%); and (3) high continuity, low-income, non-contracted individual mobility class (50.7%). Urban and Rural Resident Basic Medical Insurance and urban hukou were positively associated with higher CPBMI probability. In contrast, higher education, better self-rated health, female gender, supplementary insurance coverage, and platform-insurance enrollment linkage were associated with a higher interrupt probability of CPBMI.

This study highlights the low CPBMI rate. The diverse patterns of CPBMI-OC among PWNFEs underscore the systemic challenges associated with flexible BMI enrollment options, which hinder continuous insurance participation. Our findings emphasize the need for targeted policy interventions to address structural inequities, improve the inclusiveness of BMI schemes, and better accommodate the diverse needs of PWNFEs.