The association between social integration and utilization of primary health care among migrants in China: a nationwide cross-sectional study

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Abstract

Background

Migrants is a large population in China. To improve the health and wellbeing of migrants is a critical policy and social issue in China, and to enhance the utilization of primary health care by migrants is one of the most important approaches in promoting equity in health. However, there exists little research about the association between social integration and the utilization of primary health care. To address the research gap, this research aims at exploring the relation between social integration and the utilization of primary health care among migrants in China.

Methods

Using the national data from China Migrants Dynamic Survey (CMDS) in 2017, 169,989 migrants were included in this study. Social integration was measured by social communication, acculturation and self-identity, with 8 indicators. The utilization of primary health care was measured by the receiving of health education on infectious diseases (ID) and noncommunicable diseases (NCD) as well as the first visit institution when migrants were sick. After the descriptive statistical analysis, binary logistic regression was employed to evaluate the association between social integration and the utilization of primary health care.

Results

65.99% of the migrants received health education on infectious diseases (ID), 40.11% of the migrants received health education on noncommunicable diseases (NCD) and 8.48% of the migrants chose to go to Community Health Center (CHC) seeking for health services. There was a positive effect of social organization participation, the influence of hometown customs, differences of hygiene habits between migrants and local people, integration willingness and evaluation of identity on the receiving of health education on ID and NCD, as well as a positive effect of civil activities engagement and differences of hygiene habits between migrants and local people on the utilization of CHC after getting sick.

Conclusions

Social integration was associated with the utilization of primary health care among migrants in China. Generally speaking, greater social integration was associated with higher possibility of receiving health education on ID and NCD. However, the effect of social integration on the utilization of CHC was more complex among different indicators. There should be more policy interventions to improve the social integration of migrant which help them to get familiar with the health resource available, as well as improve the capacity of CHC.

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Most cited references 24

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Public Health Services Utilization and Its Determinants among Internal Migrants in China: Evidence from a Nationally Representative Survey

Jingya Zhang, Senlin Lin, Di Liang … (2017)

There have been obstacles for internal migrants in China in accessing local public health services for some time. This study aimed to estimate the utilization of local public health services and its determinants among internal migrants. Data were from the 2014 and 2015 nationally representative cross-sectional survey of internal migrants in China. Multivariate logistic regressions were used to estimate the relationship between socioeconomic, migration, and demographic characteristics and public health services utilization. Our results showed that internal migrants in more developed eastern regions used less public health services. Those with higher socioeconomic status were more likely to use public health services. The years of living in the city of residence were positively associated with the utilization of public health services. Compared to migration within the city, migration across provinces significantly reduced the probability of using health records (OR = 0.88, 95% CI: 0.86–0.90), health education (OR = 0.97, 95% CI: 0.94–1.00), and health education on non–communicable diseases (OR = 0.92, 95% CI: 0.89–0.95) or through the Internet (OR = 0.96, 95% CI: 0.94–0.99). This study concludes that public health services coverage for internal migrants has seen great improvement due to government subsidies. Internal migrants with lower socioeconomic status and across provinces need to be targeted. More attention should be given to the local government in the developed eastern regions in order to narrow the regional gaps.

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Factors associated with health-seeking behavior among migrant workers in Beijing, China

Yingchun Peng, Wenhu Chang, Haiqing Zhou … (2010)

Background Migrant workers are a unique phenomenon in the process of China's economic transformation. The household registration system classifies them as temporary residents in cities, putting them in a vulnerable state with an unfair share of urban infrastructure and social public welfare. The amount of pressure inflicted by migrant workers in Beijing, as one of the major migration destinations, is currently at a threshold. This study was designed to assess the factors associated with health-seeking behavior and to explore feasible solutions to the obstacles migrant workers in China faced with when accessing health-care. Methods A sample of 2,478 migrant workers in Beijing was chosen by the multi-stage stratified cluster sampling method. A structured questionnaire survey was conducted via face-to-face interviews between investigators and subjects. The multilevel methodology (MLM) was used to demonstrate the independent effects of the explanatory variables on health seeking behavior in migrant workers. Results The medical visitation rate of migrant workers within the past two weeks was 4.8%, which only accounted for 36.4% of those who were ill. Nearly one-third of the migrant workers chose self-medication (33.3%) or no measures (30.3%) while ill within the past two weeks. 19.7% of the sick migrants who should have been hospitalized failed to receive medical treatment within the past year. According to self-reported reasons, the high cost of health service was a significant obstacle to health-care access for 40.5% of the migrant workers who became sick. However, 94.0% of the migrant workers didn't have any insurance coverage in Beijing. The multilevel model analysis indicates that health-seeking behavior among migrants is significantly associated with their insurance coverage. Meanwhile, such factors as household monthly income per capita and working hours per day also affect the medical visitation rate of the migrant workers in Beijing. Conclusion This study assesses the influence of socio-demographic characteristics on the migrant workers' decision to seek health care services when they fall ill, and it also indicates that the current health service system discourages migrant workers from seeking appropriate care of good quality. Relevant policies of public medical insurance and assistance program should be vigorously implemented for providing affordable health care services to the migrants. Feasible measures need to be taken to reduce the health risks associated with current hygiene practices and equity should be assured in access to health care services among migrant workers.

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Improving the utilization of essential public health services by Chinese elderly migrants: strategies and policy implication

Shangfeng Tang, Chengxu Long, Ruoxi Wang … (2020)

Background The concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants’ utilization of the essential public health services and its underlying factors on account of change of residence, and social support. Methods Data came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants. Results Approximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants’ utilization of essential public health services. Conclusions The utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.

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Author and article information

Contributors

Xueyao Wang: 3045725097@qq.com

Jue Liu: jueliu@bjmu.edu.cn

Jingmin Zhu: jingmin.zhu@ucl.ac.uk

Yang Bai: baiyangbeatrice@163.com

Jun Wang: hpreruc2022@126.com

Journal

Journal ID (nlm-ta): Int J Equity Health

Journal ID (iso-abbrev): Int J Equity Health

Title: International Journal for Equity in Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-9276

Publication date (Electronic): 9 October 2023

Publication date PMC-release: 9 October 2023

Publication date Collection: 2023

Volume: 22

Electronic Location Identifier: 210

Affiliations

[1 ]Center for Health Policy Research and Evaluation, Renmin University of China, ( https://ror.org/041pakw92) Beijing, 100872 China

[2 ]School of Public Administration and Policy, Renmin University of China, ( https://ror.org/041pakw92) Beijing, 100872 China

[3 ]Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, ( https://ror.org/02v51f717) Beijing, 100080 China

[4 ]Institute for Global Health and Development, Peking University, ( https://ror.org/02v51f717) Beijing, 100871 China

[5 ]Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing, 100083 China

[6 ]Department of Epidemiology and Public Health, University College London, ( https://ror.org/02jx3x895) London, WC1E 7HB UK

[7 ]Beijing Famous Cultural Artist Studio--Health Beijing Governance Theory Creation Studio, Beijing, 100872 China

Article

Publisher ID: 2018

DOI: 10.1186/s12939-023-02018-x

PMC ID: 10561491

PubMed ID: 37814276

SO-VID: 31c89c6b-3518-43f1-bcfe-efb03903caa6

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 17 April 2023

Date accepted : 19 September 2023

Funding

Funded by: Renmin University of China: the special developing and guiding fund for building world-class universities (disciplines)

Award ID: 2022026

Funded by: National Natural Science Foundation of China

Award ID: 72122001

Award ID: 72042002

Funded by: Beijing famous cultural Artist Studio--Health Beijing Governance Theory Creation Studio, Evaluation and Research on Medical and Health Reform of Four Talent Projects of National Famous Cultural Experts

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ScienceOpen disciplines: Health & Social care

Keywords: migrants,social integration,utilization of primary health care

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ScienceOpen disciplines: Health & Social care

Keywords: migrants, social integration, utilization of primary health care

The association between social integration and utilization of primary health care among migrants in China: a nationwide cross-sectional study

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Most cited references 24

Public Health Services Utilization and Its Determinants among Internal Migrants in China: Evidence from a Nationally Representative Survey

Factors associated with health-seeking behavior among migrant workers in Beijing, China

Improving the utilization of essential public health services by Chinese elderly migrants: strategies and policy implication

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