The analysis above showed that the contextual factors including policy and economic contexts were important factors influencing rural disabled persons’ participating in social medical insurance in China and unemployment. Furthermore, severer disability degree and social isolation might also deeply violate their equal access to social medical insurance. In China, policy is the most important factor influencing the rural disabled persons’ participation in social medical insurance. Our results showed that the odds of participating in social medical insurance of rural disabled persons in NPC were 3.34 times larger as compared to those in non-NPC, which also applies to the real situation.
At the end of 2003, China began to launch NRCMS pilots in part of China
, which amounted to about 40% of the national counties (cities and districts) in 2006
. The social medical insurance participation rates in various pilot studies have been on the rise since 2003 with the spread of NRCMS pilots. Wusheng county, the NPC in Sichuang province since August 2003, had a total of 1,311,000 person-times participating in social medical insurance over the past three years, of which 435,100 participated from 2003 to 2004 (participation rate=61%), 371,000 (51%) in 2005 and 504,900 (69%) in 2006
. Meanwhile, the low self-paid premium of NRCMS largely promoted rural disabled persons’ participation in social medical insurance. In 2003, the minimum annual self-paid premium of NRCMS was only 10 Yuan while the corresponding average payment of the medical insurance for urban workers was 271 Yuan
. Therefore, the policy was the most important factor influencing rural disabled persons’ participation in social medical insurance. However, there was no NRCMS related central policy specified for rural disabled persons, which might influence rural disabled persons’ participation in social medical insurance, especially those with lower PCHI or more severe disability degree.
These results showed that the odds of participating in social medical insurance of rural disabled persons in the area with rehabilitation stations were 1.87 times larger than those without rehabilitation stations. In 2002, “Views on Further Strengthening Rehabilitation Work for Disabled Persons”
 pointed out the importance of introducing rehabilitation work into the community for disabled persons by gradually providing the community and household rehabilitation services to the disabled persons in order to raise funds through multiple channels for the rehabilitation aid of poor disabled persons, to construct the rehabilitation infrastructure for disabled persons and to carry out post-rehabilitation professional and labor skills to promote education, employment and full participation in society for disabled persons. The establishment of rehabilitation stations might reflect the enforcement of rehabilitation policy. Strict enforcement of this policy can largely promote rehabilitation services, skill training, education and employment for disabled persons, which could increase the probability of their participation in social medical insurance.
These results showed that the rural disabled persons with higher PCHI or in the area with higher PCIV were more likely to participate in medical insurance. The areas with better economic status might provide more preferential policies for the rural disabled, such as lower self-paid premium and higher hospitalization reimbursement. Our results showed that the rural disabled persons in the areas with better economic status had higher initiatives to participate in social medical insurance. Although the minimum self-paid premium of NRCMS was only 10 Yuan, the rural disabled persons with low income were more likely to spend the money on consumer goods to obtain maximum utility. The satisfaction survey of NRCMS in Liaoning province showed that the farmers with a better economic status or better health status showed higher satisfaction with NRCMS
. Thus rural disabled persons with worse economic status or worse health status benefited less from NRCMS. Furthermore, due to the low financing level, low reimbursement rate and limited disease coverage, without corresponding preferential policies, the rural disabled with poor economic status had low initiatives to participate in social medical insurance.
The odds of participating in social medical insurance of employed rural disabled persons were 1.11 times higher than that of the unemployed. In 2006, the social medical insurance in China was mainly consisted of medical insurance for urban workers, which had already been spread all over China, and NRCMS, which only piloted in a part of China. Medical insurance for urban workers covered all the workers of townships and village enterprises. Therefore, the employed rural disabled persons were covered by medical insurance for urban workers and obtained medical security.
As for the disability degree and participation in society, rural disabled persons with more severe disability or barriers were less likely to participate in social medical insurance. The disability reduced the probability of being employed, especially for those with severe disability, thus reduced the odds of participation in social medical insurance. Also, disability and unemployment worsened the economic status and restrained their knowledge of policy due to the barriers thus reduced the odds of participation in social medical insurance. Based on these findings, we concluded that China rural disabled persons’ medical security was constrained by their disabilities and social participation barriers before 2006, which might have seriously prevented them from gaining equal access to medical security.