Round 1

Reviewer 1 Report

This is a very interesting study on health policy in China. A broad readership (including the reviewer) will discover the growing concerns about health care insurance associated with the dramatic urbanization occuring in China. 

The submission is well written, its methods appropriately organized, results are convincing. Statistical analysis is properly performed. 

The submission may be improved in 2 ways.

1 adding 3 additional references from China (see attached file)

2 provide a comparison with other large rural to urban migration areas, e.g Africa, where such health policies have also been (rarely) proposed, but where healthcare assurances are lacking in most instances -except for Senegal, Algeria, Tunesia, Tanzania and few other countries) 

Zhao J, et al. Intended place of residence in old age of internal migrants aged 15-64 years: a citywide cross-sectional study in Shanghai, China. BMJ Open 2019.

Peng BL, et al. BMC Public Health. 2019 Jan 18;19(1):86. doi: 10.1186/s12889-019-6416-y.Association between rural-to-urban migrants' social medical insurance, social integration and their medical return in China: a nationally representative cross-sectional data analysis. Without social medical insurance in the destination areas and with low social integration, rural-to-urban migrants had barriers to health service in the destination areas, some of the migrants had to seek health service in hometown, namely medical return. This study aimed at exploring the association between rural-to-urban migrants' medical return and social medical insurance type or social integration. Four thousand eighteen rural-to-urban migrants living in current residence at least one year and used inpatient service within the last 12 months were analysed. The rate of medical return for inpatient service was 15.3%. Having medical insurance of hometown (new rural cooperative medical scheme (NRCMS)) (OR = 2.44, 95%CIs 1.80-3.30) was positively related to the medical return. The permanent settlement intention was negatively associated with the medical return (OR = 0.66, 95%CIs 0.48-0.90).




Han J, et al. Int J Equity health 2019. Institutional differences and geographical disparity: the impact of medical insurance on the equity of health services utilization by the floating elderly population - evidence from China.

The Chinese government has now achieved universal coverage of medical insurance through two systems: the Basic Medical Insurance System for Urban Employees (BMISUE) and the Basic Medical Insurance System for Urban and Rural Residents (BMISURR). This paper aims to identify the impact of China's current medical insurance system on equity in the use of health services by the floating elderly population from two aspects: institutional differences and geographical disparity For the BMISURR, when the place of the insurance is the same as the place of residence, the proportion of the floating elderly population that will see a doctor when they are sick will increase by 4.80%. The difference between the place of insurance and the place of residence results in the unbalanced utilization of health services by the floating elderly population participating in the same medical insurance system

Author Response

Thanks to your review and valuable advice.

I have made modification according to your suggestions. You could find them in the manuscript in red. I hope you will be satisfied with the modification.

Firstly, all of 3 additional references was added into the manuscript in the last paragraph of Introduction part in Line 101. 

Secondly, I provided a comparison of health insurance holding by migrants in Ghana of Africa in Discussion part in Line 286.

Reviewer 2 Report

Thank you for the opportunity to review this study.  The demographics of aging raise global economic, political, social, and public health concerns (Cheng, Gao, Li, Zhang, & Rosenberg, 2019; Su & Wang, 2019; Yang & Huo, 2019). China's situation is particularly challenging because it is projected to have the largest number of citizens aged 80+ by 2050 (Su & Wang, 2019). While some research exists on the general health of the elderly population in China, this study contributes specific findings on elderly rural migrants in urban cities, validates the magnitude of the medical economic burden, and raises consciousness about the ramifications of national health insurance.

The following mechanic issues are suggested for the authors' consideration:

Line 54
in order to attenuated [should be attenuate]

Line 77
but choose [should be chose] no medical services

Line 97
alleviated [should be alleviate]

Line 120
all of medical expenditures , [delete extra space before comma]

Line 169
who got had severe illnesses [should be "who had" severe illnesses]

Line 223
with medical insurance one excellent example. [might be better to say "one illustrative example."]

References
Cheng, Y., Gao, S., Li, S., Zhang, Y., & Rosenberg, M. (2019). Understanding the spatial disparities and vulnerability of population aging in China. Asia & the Pacific Policy Studies, 6(1), 73-89.

Su, S. W., & Wang, D. (2019). Health-related quality of life and related factors among elderly persons under different aged care models in Guangzhou, China: a cross-sectional study. Quality of Life Research, 28(5), 1293-1303.

Yang, Z., & Huo, A. (2019, June). Optimization of Rural Mutual Assistance Pension Mode under the Background of Aging Population. In 3rd International Conference on Economics and Management, Education, Humanities and Social Sciences (EMEHSS 2019). Atlantis Press.

Author Response

Thank you for the review and valuable advice for this manuscript. You can find every modification in the manuscript in red. 

All of the following sentences and references was added into the first paragraph of discussion part (in Line 228)."The demographics of aging raise global economic, political, social, and public health concerns (Cheng, Gao, Li, Zhang, & Rosenberg, 2019; Su & Wang, 2019; Yang & Huo, 2019). China's situation is particularly challenging because it is projected to have the largest number of citizens aged 80+ by 2050 (Su & Wang, 2019). While some research exists on the general health of the elderly population in China, this study contributes specific findings on elderly rural migrants in urban cities, validates the magnitude of the medical economic burden, and raises consciousness about the ramifications of national health insurance." "Cheng, Y., Gao, S., Li, S., Zhang, Y., & Rosenberg, M. (2019). Understanding the spatial disparities and vulnerability of population aging in China. Asia & the Pacific Policy Studies, 6(1), 73-89. Su, S. W., & Wang, D. (2019). Health-related quality of life and related factors among elderly persons under different aged care models in Guangzhou, China: a cross-sectional study. Quality of Life Research, 28(5), 1293-1303. Yang, Z., & Huo, A. (2019, June). Optimization of Rural Mutual Assistance Pension Mode under the Background of Aging Population. In 3rd International Conference on Economics and Management, Education, Humanities and Social Sciences (EMEHSS 2019). Atlantis Press."

Line 54

"in order to attenuated" was modified as"in order to attenuate".

Line 77

"but choose no medical services" and Line 97 "alleviated" were not modified because combining with a context, the former expression was fitted.

Line 120 (now in Line 126)

"all of medical expenditures ," I have delete extra space before comma thanks to your advice.

Line 169 (now in Line 175)

"who got had severe illnesses" was modified as "who had severe illnesses".

Line 223 (now in Line 235)

"with medical insurance one excellent example" was modified as "with medical insurance one illustrative example"