Abstract
BackgroundMigrants are the unique production of China’s urbanization process. They are often excluded from social welfare and security systems of cities, and often exposed to high health risk related closely to their health problems. This research sought to unveil and explore the influencing factors on health services utilization of migrants in Beijing.MethodsA sample of 2014 inter-provincial migrants and 4578 residents with Beijing “Hukou” who were 15 years old and above was chosen by three-stage stratified cluster sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Anderson health service utilization model was used to demonstrate the effects of the explanatory variables on health seeking behavior from predisposing, enabling and need variables.ResultsThe study reveals that the rate of ‘having symptoms’ of migrants was lower than that of residents with “Hukou” only in the group of 25 to 34 years old in the past month. 503 migrants (25.0%) and 1441 (31.5%) residents with “Hukou” reported at least one episode of discomfort in the past month, and the rate of health service seeking behavior among migrants (46.8%) was lower than residents with “Hukou” (62.6%) (P < 0.0001). Chi-square independence test shows that age, ethnicity, employment status, having chronic disease and the degree of symptom were the major determinants affecting migrants to receive health services. The binary logistic regression indicates that the degree of symptom as the need variable and ethnicity as the predisposing variable were the strong and consistent determinants of health services seeking behavior. The migrants with moderate degree and severe degree of symptom in the past month were at 1.623-times (OR = 1.623) and 5.035-times (OR = 5.035) higher chances of seeking health services respectively, comparing to mild degree of symptom. Minority migrants were less likely to seek health services than Han migrants (OR = 0.282).ConclusionsThe results indicate that the current health delivery system is not conducive for migrants to seek appropriate health services. Relevant policies and feasible measures, including increasing the coverage of health insurance and improving the health perception of migrants should be vigorously implemented to provide affordable health services and change health service utilization behaviors for migrants.
Highlights
Migrants are the unique production of China’s urbanization process
In the process of migration flows, migrants contribute significantly to urban socioeconomic development and social stability. They are notoriously marginalized in China, especially due to a rigid household registration system-called “Hukou”, that serves as a domestic passport, which regulates population distribution and rural-to-urban migration
In the unstable context with a lack of family supports, public infrastructure and social support network, migrants suffer from unnoticed high health risks that can wear off their health risk awareness and make them vulnerable to long-term health problems [10,11,12]
Summary
Migrants are the unique production of China’s urbanization process. They are often excluded from social welfare and security systems of cities, and often exposed to high health risk related closely to their health problems. The estimate of migrants increased from 230 million in 2011 to 247 million in 2015, which constituted 18% of the total population of China [1, 2]. In the process of migration flows, migrants contribute significantly to urban socioeconomic development and social stability. While, they are notoriously marginalized in China, especially due to a rigid household registration system-called “Hukou”, that serves as a domestic passport, which regulates population distribution and rural-to-urban migration. In the unstable context with a lack of family supports, public infrastructure and social support network, migrants suffer from unnoticed high health risks that can wear off their health risk awareness and make them vulnerable to long-term health problems [10,11,12]
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