Voting with Your Feet: The Impact of Urban Public Health Service Accessibility on the Permanent Migration Intentions of Rural Migrants in China

Abstract

The accessibility of urban public health services is not only relevant to the health status of rural migrants but also plays an increasingly important role in their migration decisions. Most existing studies have focused on the effects of the level of public health service provision and parity on rural migrants’ migration behavior, ignoring the role of public health service accessibility. This paper systematically examines the overall impact, heterogeneous impact and mechanism of action of public health service accessibility on rural migrants’ intentions to migrate permanently based on data from the 2017 China Mobile Population Dynamics Monitoring Survey using probit, IVprobit, eprobit, omitted variable test model and KHB mediating effect model. It was found that: (1) public health service accessibility significantly increased rural migrants’ intentions to migrate permanently, and the results remained robust after using instrumental variables to mitigate endogeneity problems and omitted variable tests. (2) Heterogeneity analysis shows that public health service accessibility has a greater effect on enhancing the intentions to migrate permanently among females and rural migrants born in 1980 and later. (3) Further mechanism testing revealed that public health service accessibility could indirectly increase rural migrants’ intentions to migrate permanently by improving health habits, health status, identity, and social integration, with identity playing a greater indirect effect. The findings of this paper not only provide empirical evidence for the existence of Tiebout’s “voting with your feet” mechanism in China but also contribute to the scientific understanding of the role of equalization of public health services in the process of population migration.

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

“…It is necessary to examine the policies of basic public health service equalization that enhance the accessibility of health rights for ethnic minority rural migrants. Firstly, the core content of public health services is public health, and the original intention of public health is to safeguard the basic human right of health [ 13 ]. The improvement of accessibility to health rights in the destination area can enable ethnic minority rural migrants to more widely access, understand, and utilize health information, thereby enriching their health knowledge, enhancing health literacy, fostering good health habits, mitigating health risks, and ultimately improving health levels.…”

“…A significant portion of minority rural migrants relocate from their hometowns to urban areas in pursuit of better job opportunities, higher income, and the aspiration to become urban residents [ 13 ]. Existing studies indicate that the essence of the urbanization process can be understood not only as the transformation of rural and urban household registrations but also as the gradual process by which rural migrants gradually enjoy the same basic public services as local urban residents [ 14 , 15 ].…”

“…Existing studies indicate that the essence of the urbanization process can be understood not only as the transformation of rural and urban household registrations but also as the gradual process by which rural migrants gradually enjoy the same basic public services as local urban residents [ 14 , 15 ]. However, it is crucial to note that minority rural migrants can only enjoy equal public health services as local residents after completing household registration migration [ 13 , 16 ]. In comparison to the nation’s high attention and rapid progress in the top-level design and practical implementation of public health services, there is a somewhat lagging development in standardized and in-depth academic research in the field of public health services.…”

“…In comparison to the abundant literature focusing on the utilization and influencing factors of public health services, there is relatively less research on the impact of health rights accessibility. In particular, some of the related literature has focused on macrolevel assessments of the economic and social impacts of public service investments, especially the potential driving effects of institutional design, value positions, and the supply quality of public services in urban receiving areas on the migration decisions and citizenship levels of rural migrants [ 13 , 28 – 30 ]. Only a small number of studies have empirically analyzed the impact of the equalization of public health services on the social integration of rural migrants, suggesting that the utilization of public health services contributes to enhancing the social integration of rural migrants [ 31 ].…”

Local Government’s Land Finance Dependence and Migrants’ Settlement Intentions: Evidence from China

“…However, this view is problematic because migration is common in some countries where there is no household registration [22,23]. In recent years, other aspects of macro policies have attracted the attention of researchers, such as public service or social security, all of which have an impact on the settlement intentions of migrants [24,25]. The increase in public service is conducive to the increase in the settlement intentions of migrants, and this increase more significantly impacts the settlement intentions of women, less-educated, and rural migrants [26].…”