Should the poor have no medicines to cure? A study on the association between social class and social security among the rural migrant workers in urban China

Why don't Chinese college students seek help from the National Health Service (NHS)? Chinese college students' use of medical services in the UK

Background

International students have a lower utilization rate of the local medical service system for studying abroad, and it has been found that there may be multiple reasons behind this phenomenon. This study explores the usage of medical service systems by international students and the underlying logical factors through a study of the usage of National Health Service (NHS) of Chinese students in the UK.

Methods

To address the research questions, this study employed an online survey methodology that ran between 1st May and August 20, 2019 facing the Chinese students in the UK. A total of 1,050 questionnaires were distributed and 1,001 questionnaires were recovered, of which 977 contained valid responses (questionnaire response rate was 95.3 % and validity rate was 97.6 %). Before the questionnaire was designed and after it was issued, two focus group interviews were conducted to provide reliable and detailed information to inform the questionnaire design and to supplement the questionnaire survey data with more profound psychological qualitative data. The two focus groups consisted of 10 and 12 Chinese students studying in the UK and each lasted more than 3 h.

Results

The survey data showed that the medical services utilization rate of Chinese students in the UK is relatively low compared to UK residents and domestic Chinese students. Their decisions and behaviours around medical services usage in the UK are not significantly related to age, gender, and monthly income, but are instead related to their current education status, types of disease suffered, and information acquisition about the UK medical services before coming to the UK. When getting sick, in addition to seeking help from official medical services, Chinese students studying in the UK tend to self-diagnose and self-medicate; seeking help from social networks based on friendship and domestic relatives are also alternatives to accessing medical services.

Conclusion

Combining the theories of 'sick role' and 'illness experience', the decisions and behaviours related to medical services usage by Chinese students in the UK are significantly influenced by their understanding of medical services, which is socially and culturally learned in China. Understanding the perspective of the 'sick role' and the 'illness experience' of Chinese students may help to better think about how improvements can be made to their utilization rate of medical services and their health status during their studies in the UK. This study not only provides us with specific information and understanding on the usage of medical services for Chinese students in the UK, but the research results may also provide a reference for other similar research on the health and medical service use of other international students studying in the cross-cultural contexts.

The prevalence of preterm and low birth weight infants among migrant women in the Pearl River Delta region, China: a population-based birth cohort study

BACKGROUND

The existing literature evaluating the association between neonatal morbidity and migrant status presents contradictory results. The purpose of this study was to compare the risk of preterm birth (PTB) and low birth weight (LBW) among newborns from local and migrant women in China's Pearl River Delta (PRD) region.

METHODS

In this observational population-based study, we included all live singleton deliveries from PRD region local women and migrant women. Data were sourced from the Guangdong Medical Birth Registry Information System between Jan 1, 2014, and Dec 31, 2020. Women were categorized into three groups by maternal migrant status: local women from PRD region, migrant women from Guangdong province or from other provinces. The outcome variables that were examined included two adverse birth outcomes: PTB and LBW. The association between the risk of PTB and LBW and maternal migrant status was assessed using logistic regression.

RESULTS

During 2014-2020, 5,219,133 single live deliveries were recorded, corresponding 13.22% to local women and the rest to migrant women coming from Guangdong (53.51%) and other provinces (33.26%). PTB prevalence was highest among local women (5.79%), followed by migrant women from Guangdong (5.29%), and the lowest among migrants from other provinces (4.95%). This association did not change after including maternal age, infant sex, delivery mode, and birth season in the models. Compared to local women, migrant women from other provinces had a lower risk of LBW (4.00% vs. 4.98%, P < 0.001). The prevalence of PTB and LBW was higher among local women than migrants. The odds of delivery PTB and LBW were higher for women who were age ≥ 35. Among the three maternal migration groups, the age-LBW association displayed a typical U-shaped pattern, with those in the youngest (16-24 years) and oldest (≥ 35) age categories exhibiting the higher odds of delivering a LBW neonate. With respect to infant sex, the prevalence of PTB was significantly higher in males than females among the three maternal migration groups. An opposite trend was found for LBW, and the prevalence of LBW was higher in females among the three maternal migration groups.

CONCLUSION

The findings of this study contribute to the understanding of the epidemiology of PTB and LBW among migrant women. Our study suggests that it is the health and robust nature of migrant mothers that predisposes them to better birth outcomes. It is important to recognize that the results of this study, while supportive of the healthy migrant effect, cannot be considered definitive without some exploration of motivation for moving and changes in lifestyle postmigration.

Health service behaviors of migrants: A conceptual framework

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

The Impact of Rural Population Mobility on Fertility Intention under the Comprehensive Two-Child Policy: Evidence from Rural China

Declining fertility rates pose challenges to global economic, social, cultural and political development. Low fertility rates among rural floating populations are exacerbating these challenges. However, it is not clear whether and to what extent rural population mobility (RPM) has reduced migrants' willingness to have children. At the same time, rural migration may represent a self-selection behavior (i.e., selection bias), and traditional measurement methods may be insufficient for effectively estimating the quantitative impacts of rural migration. Accordingly, the data from 1734 rural households from 28 provinces in mainland China were collected in the current study, and endogenous switching regression (ESR) models were used to correct the selection bias to quantitatively evaluate the impacts of RPM on fertility intention. The results revealed the following: (1) For rural residents who choose to move, if they chose not to move, their willingness to give birth would increase by 19.820%, their willingness to have female children would increase by 48.526%, and their willingness to have male children would drop by 26.711%. (2) For rural residents who choose not to move, if they chose to move, their willingness to give birth would drop by 55.982%, their willingness to have female children would drop by 18.294%, and their willingness to have male children would drop by 55.106%. (3) For eastern rural residents who choose to move, if they chose not to move, their willingness to give birth would decrease by 40.273%. For midwestern rural residents who choose to move, if they chose not to move, their willingness to give birth would increase by 24.786%. (4) For eastern rural residents who choose not to move, if they chose to move, their willingness to give birth would increase by 11.032%. (5) For midwestern rural residents who choose not to move, if they chose to move, their willingness to give birth would drop by 71.744%. The abovementioned findings can provide research support for other low-fertility countries or regions toward increasing fertility rates and addressing any imbalances in current gender ratios. They can also help to provide realistic strategies for alleviating the global population crisis.

Factors associated with child delivery expenditure during the transition to the national implementation of the two-child policy in China

BACKGROUND

This study aimed to analyze the status of birthrates and the characteristics of child delivery expenditure under the Chinese two-child policy's transition period. We evaluated the socioeconomic factors associated with child delivery and provide evidence for decisions relating to health support for childbirth.

METHODS

Child delivery expense data were obtained from 2015 to 2017 in Dalian, China. A total of 13,535 obstetric records were enrolled using stratified random sampling and the proportional probability to size method. First, we calculated the current curative expenditure of child delivery and health financing in childbirth costs based on the System of Health Accounts 2011 (SHA 2011). Second, univariate analysis of variance and generalized linear modeling were performed to examine factors associated with child delivery expenditure. Third, we classified the included hospitals into the county, district, and municipal hospitals and compared maternal characteristics between these categories.

RESULTS

Overall, out-of-pocket payments accounted for more than 35% of the total expenditure on child delivery. Median (interquartile range) delivery expenditure at the county and district level hospitals [county-level: 5128.50 (3311.75-5769.00) CNY; district-level: 4064.00 (2824.00-6599.00) CNY] was higher than that at the municipal level hospitals: 3824.50 (2096.50-5908.00) CNY. The increase of child delivery expenditure was associated with an increased ratio of reimbursement, admissions to county and district level hospitals, cesarean sections, and length of stay, as well as a decline in average maternal age (p < 0.05).

CONCLUSIONS

Health financing for childbirth expenditure was not rational during the transition period of the family planning policy in China. Higher delivery expenditure at county and district level hospitals may indicate variations in medical professionalism. Poorly managed hospitalization expenditure and/or nonstandard medical charges for childbirth, all of which may require the development of appropriate public health policies to regulate such emerging phenomena.

Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China

BACKGROUND

Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.

METHODS

The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level.

RESULTS

Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively.

CONCLUSION

This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: a systematic review and policy gap analysis

BACKGROUND

More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China's total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China.

METHODS

A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed.

RESULTS

(1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers.

CONCLUSION

It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW's characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW's job stability.

The mental health and depression of rural-to-urban migrant workers compared to non-migrant workers in Shanghai: a cross-sectional study

BACKGROUND

Migrant workers worldwide commonly are susceptible to mental disorders. Since the 1980s, there has been a large-scale increase in the number of migrant workers in China; this development parallels the acceleration of socio-economic transformation. Studies addressing this population rarely focus on workers' mental health or psychological well-being, yet it is imperative to understand the mental health status of rural-to-urban migrant workers and study the relationship between migration and mental health.

METHODS

A cross-sectional survey of 3286 participants (response rate 85.4%) was conducted among different work units in Shanghai. All of the variables of this survey were assessed by a self-administered questionnaire, with depression measured by the Patient Health Questionnaire-9 (PHQ-9) scale and poor mental health (PMH) measured by the World Health Organization 5-Item Well-Being Index (WHO-5) scale. Pearson's χ2 test and logistic regression were used to compare migrants with urbanites, and to identify factors related to mental health outcomes.

RESULTS

Migrant workers (15.3%) had a slightly higher prevalence of depression than non-migrant (12.0%) workers, with notable PMH (26.9%) among participants >45 y of age. In the logistic regression models, those who reported low job satisfaction, unhealthy organizations, poor physical health (self-rated) and long working hours were 2.86 (95% CI 2.14 to 3.84), 1.42 (95% CI 1.06 to 1.91), 1.89 (95% CI 1.41 to 2.55) and 1.48 (95% CI 1.08 to 2.03) times more likely to have depression, respectively. Similarly, workers >45 y of age were 2.92 (95% CI 1.65 to 5.16) and 1.80 (95% CI 1.01 to 3.21) times more likely to have PMH for low job satisfaction and unhealthy organizations, respectively.

CONCLUSIONS

There are numerous potential causes affecting the mental health of Chinese internal migrant workers. Strengthening the construction of healthy organizations and enhancing workers' job satisfaction may improve the mental health status or psychological well-being of this group.

'I dodged the stigma bullet': Canadian sex workers' situated responses to occupational stigma

Stigma attached to sex workers' occupation, sometimes disparagingly referred to as 'prostitution' or 'whore' stigma, is a fundamental challenge for people in sex work. Yet sex workers are not powerless when confronting occupational stigma. We employed thematic analysis with data from in-person interviews conducted in 2012-13 with a diverse sample of 218 adult sex workers in Canada. Our participants perceived a high degree of occupational stigma, which they responded to and managed using four main strategies. First, some participants internalised negative discourses about their sex work and accepted their discredited status. Second, many controlled access to information about themselves, consciously keeping knowledge of their occupation from most people while sharing it with trusted others. Third, some participants rejected society's negative view of their occupation. Finally, some attempted to reduce the personal impact of stigma by reframing sex work to emphasise its positive and empowering elements. Participants often strategically responded to stigma contingent on the situated contexts of their work and personal life. We discuss these findings in relation to the existing knowledge base about stigma attached to sex workers' occupation as well as how these findings may direct future research on stigma strategies.