Determinants of Differences in Health Service Utilization between Older Rural-to-Urban Migrant Workers and Older Rural Residents: Evidence from a Decomposition Approach

Abstract

Background: The widening gap in health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Our study explored the existence of differences and the causes of the differences in the health service utilization of older rural-to-urban migrant workers in comparison to older rural dwellers. Further, our study explored socioeconomic differences in health service utilization. Methods: The data from the China Labor-Force Dynamic Survey in 2016, the data from the Urban Statistical Yearbook in 2016, and the Statistical Bulletin were used. Our study applied the latest Andersen Model according to China’s current situation. Before we studied health service utilization, we used Coarsened Exact Matching to control the confounding factors. After matching, 2314 respondents were successfully matched (859 older rural-to-urban migrant workers and 1455 older rural dwellers). The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts. Results: After matching, the probability two-weeks outpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). Overall, 17.98% of the total difference for two-week outpatient utilization was due to the observed influence factors. Moreover, 71.88% of total difference in inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), health self-assessments (80.91%), and the sex ratio in the community (−102.29%) were significant in the differences in inpatient utilization. Conclusions: The findings provide important insights into the socioeconomic differences in health service utilization among older rural-to-urban migrant workers and older rural residents in China. These insights urge the government to take full account of the heterogeneity in designing health security system reform and public health interventions targeting vulnerable groups.

Effect of health rights accessibility on the urban integration of minority rural migrants in China: a cross-sectional study

“…Additionally, health equity accessibility has a more substantial facilitating effect on urban integration for minority rural migrants with illness experience. This is mainly because only when minority rural migrants encounter diseases and genuinely experience the medical benefits brought about by local health equity accessibility does health equity accessibility positively influence their urban integration [ 77 , 78 ].…”

“…However, the Suest test results indicate that the promoting effect of health rights accessibility on urban integration is more significant for minority rural migrants with a history of illness. This is mainly because, compared to those without an illness history, minority rural migrants with such a history are more likely to enhance their willingness to integrate into the city due to the accessibility of health rights [ 14 , 77 , 78 ].…”

Trends and Impact Factors of Mental Health Service Utilization among Resettled Humanitarian Migrants in Australia: Findings from the BNLA Cohort Study

“…As suggested by Andersen’s framework, MHS utilization among humanitarian migrants would primarily be driven by perceived needs [ 41 , 42 ]. The proportion of having MHS contacts in humanitarian migrants with mental health conditions (approximately 50%) was much higher than that in the overall participants (approximately 30%), indicating that perceived symptoms play dominant roles in promoting contacts for MHS among humanitarian migrants in Australia.…”