Abstract
Background: Due to the household registration system, Chinese elderly migrants have insufficient access to health services and social support. Thus, this study examined the use of health services, the access to social support, and the interaction among the elderly migrating within China. Methods: Data were obtained from the China Migrant Dynamic Monitoring Survey in 2015, adopting probability proportionate to size as the sampling strategy. Structural equation modeling and mediating effect tests were employed to explore the associations. Results: Approximately 45.9% of elderly migrants did not seek health services when needed. The use of outpatient and inpatient services was more common than free essential public health services. The use of health services was negatively associated with migrating duration and migrating for offspring, while it was positively associated with outer social support. The mediating effects of outer social support were discovered on the relationships between the use of health services and independent variables such as migrating duration and migrating for offspring, respectively. Conclusion: Elderly migrants with a longer migrating duration or migrated for offspring seem to obtain less outer social support, resulting in a decreased use of health services. Outer social support was suggested as a key effort to improve the equalization of health services in Chinese elderly migrants.
Highlights
Since the new Chinese health system reform was launched in 2009, the government has increased the budget in primary healthcare delivery
Among those with disease/injury and that should be hospitalized, 18.0% did not receive inpatient services in the past year. Among those who did not use inpatient services, 38.1% attributed the lack of use to the fact that their family members thought it was unnecessary, while 3.3% attributed the lack of use to the fact that their family members failed to care if they were hospitalized
This study investigated differences in the use of different health services by elderly migrants within China, and estimated the effects of the associations and their interaction pathway, concluding with the findings as follows: the use of essential public health services was insufficient compared with the use of outpatient or inpatient services in elderly migrants; migrating duration and migrating for offspring were negatively associated with the use of community physical examinations, while outer social support demonstrated a directly positive effect; and the mediating effect of outer social support was observed in the relations between the use of health services and independent variables including migrating duration and migrating for offspring
Summary
Since the new Chinese health system reform was launched in 2009, the government has increased the budget in primary healthcare delivery. Public Health Service (EPHS), which aims to ensure that Chinese citizens have equal access to essential services and to satisfy primary health needs. Due to the household registration system, Chinese elderly migrants have insufficient access to health services and social support. The use of health services was negatively associated with migrating duration and migrating for offspring, while it was positively associated with outer social support. The mediating effects of outer social support were discovered on the relationships between the use of health services and independent variables such as migrating duration and migrating for offspring, respectively. Conclusion: Elderly migrants with a longer migrating duration or migrated for offspring seem to obtain less outer social support, resulting in a decreased use of health services. Outer social support was suggested as a key effort to improve the equalization of health services in Chinese elderly migrants
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