Healthcare in cumulatively caused migration: Hong Kong residents’ perceived Mainland healthcare quality and migration intentions in the Greater Bay Area, China

Abstract

The complex role of healthcare in migration has not been fully understood in existing studies, which are largely limited to the simple examination of migration behaviors associated with the uneven distribution of healthcare services. This study provides a more nuanced understanding by considering the subjective dimension of healthcare quality as an important part of the cumulative causation of migration thesis. We argue that migration behaviors and perceived healthcare quality in the destination are mutually constitutive, entailing a continuous reproduction process of migrations with heterogeneous patterns across social groups. These ideas are explored in the context of the Greater Bay Area, wherein Mainland healthcare quality has long been a major concern for Hong Kong residents' migration decisions. Based on structural equation modeling analysis of 3,500 responses from a survey of Hong Kong residents conducted in 2020, we found significant conditional mediating effects of perceived Mainland healthcare quality in reproducing HK-to-Mainland migrations. Recent living experiences and migration networks in Mainland are associated with positive perceptions of Mainland healthcare quality, which further enhance future migration intentions. This effect was uneven among HK residents and conditional upon individuals’ socio-economic status – weakened by a higher education level while non-linearly affected by household incomes. This study enriches the understanding of healthcare-impacted migrations and foregrounds the fundamental role of social infrastructure in facilitating and consolidating regional development.