Effects of offsite settlement of health claims on family migration decisions: evidence from a quasi-natural experiment in China

Abstract

BackgroundIn China, internal migrants have been largely unable to claim for health-care visits in the location to which they have migrated. Under the household registration system, health reimbursement can often be claimed only in the registration locality, and benefit packages are inconsistent across areas, leading to a low reimbursement rate for visits out of the insured locality. To address this issue, the central government has urged all levels of local governments to explore offsite settlement of health claims. This study aims to investigate the effect of the policy on family migration decisions. MethodsOur study covers a period when the policy was implemented intensively across prefectures within provinces. Using a difference-in-difference and propensity score matching approach, we compared changes in migration outcomes before and after the policy for households in cities that implemented the policy earlier relative to those in cities that implemented it later. Information on the timing of policy implementation was collected from government notices. Information on migrants was obtained from the 2012–2016 China Migrants Dynamic Survey, a national representative cross-sectional survey. We termed the first individual of a family to migrate, the ‘main migrant’, and observed the migration status of his or her dependents. The final sample contained 266 919 families. FindingsWe find that offsite settlement caused the probability of migrating with a spouse, at least one child, and at least one parent to increase by 1·6% (p=0·02), 5·6% (p=0·001), and 19·4% (p=0·03), respectively. We find no evidence of an increase in the number of main migrants deciding to move in response to the policy. InterpretationOur results suggest that offsite settlement of health claims will cause more family members of the main migrants to move. How the changes in migration pattern will reshape the health-care market from the demand side should be a focus of future research. FundingThis study was funded by a grant from the Young Medical Talents Training Program of Scientific Research of the Shanghai Municipal Commission of Health and Family Planning (number 20164Y0083 to MQ), and a grant from the National Science Foundation of China (number 71403057 to HJ).