Assessment of the health status and health service perceptions of international migrants coming to Guangzhou, China, from high-, middle- and low-income countries

Obstetric service demand is the main health need of the Vietnamese population in Guangxi, China: A cross-sectional study

China has become an emerging destination for international migration, especially in some Association of South East Asian Nations countries, but the situation of migrants seeking medical care in China remains unclear. A retrospective cross-sectional study was conducted in a hospital in Chongzuo, which provides medical services for foreigners, to investigate the situation of Vietnamese people seeking health care in Guangxi, China. Vietnamese patients who visited the hospital between 2018 and 2020 were included in the study. Demographic characteristics, clinical characteristics, characteristics of payment for medical costs, and characteristics of hospitalization were compared between outpatients and inpatients. In total, 778 Vietnamese outpatients and 173 inpatients were included in this study. The percentages of female outpatients and inpatients were 93.44% and 88.44% (χ2 = 5.133, P = .023), respectively. Approximately 30% of outpatients and 47% of inpatients visited the hospital due to obstetric needs. The proportions of outpatients with basic medical insurance for urban residents, basic medical insurance for urban employees, and new cooperative medical schemes were 28.02%, 3.21%, and 2.31%, respectively. In comparison, the proportion of inpatients with the above 3 types of medical insurance was 16.76%, 1.73%, and 2.31%, respectively. The proportion of different payments for medical costs between outpatients and inpatients were significantly different (χ2 = 24.404, P < .01). Middle-aged Vietnamese females in Guangxi, China, may have much greater healthcare needs. Their main medical demand is for obstetric services. Measurements should be taken to improve the health services targeting Vietnamese female, but the legitimacy of Vietnamese in Guangxi is a major prerequisite for them to access more and better healthcare services.

Network Diversity and Health Change among International Migrants in China: Evidence from Foreigners in Changchun

OBJECTIVE

Is the migration process likely to lead to sustained changes in individual social networks and health status? There are many controversies about the relationship between migrants' networks and migrants' health. An important reason may be that the constraints of specific social contexts on immigrant networks and health consequences are neglected. This study distinguished two types of social networks of international immigrants to China-their Chinese networks (Chinese-Net) and home-country networks (Motherland-Net). In addition, the study investigated the construction basis of immigrant social networks and health effects based on the Chinese context.

METHOD

A cross-sectional survey was conducted in 2017, 2018, and 2019. The survey was carried out by an on-site questionnaire survey of foreigners in China in the entry-exit hall of the National Immigration Administration. The survey asked foreigners about their immigration experience, labor and employment, social networks, and access to health care.

RESULTS AND CONCLUSIONS

Immigrants from more developed countries are more likely to succeed in establishing Chinese-Net and reduce the dependence on Motherland-Net. The Japanese and South Korean immigrants tended to be associated with their home-country compatriots, excluding the Chinese from social contacts and immigration networks. The mixed residence of non-home-country immigrants reduces both the Motherland-Net and Chinese-Net of international immigrants. From the perspective of the health effect, the establishment and expansion of Chinese-Net did not present the "bright side" of encouraging immigrants to reach a better health status. In contrast, Motherland-Net has a stronger explanatory power for the health changes in immigrants.

The Effect of Health Change on Long-Term Settlement Intentions of International Immigrants in New Destination Countries: Evidence from Yiwu City in China

Objective: Previous studies on settlement intentions have mainly focused on the explanations of social and economic rationality, culture, and institution, but insufficient attention had been paid to the relationship between health and settlement intentions. This study explored the relationship between changes in the health status of immigrants and their settlement intentions. Method: A cross-sectional survey was conducted both in 2018 and 2019. Foreigners who visited the Yiwu Municipal Exit−Entry Administration Office to extend their visas were invited to participate in the study. Quantitative data, such as the participants’ sociodemographic characteristics, job status, employment, immigration experience, key factors associated with the intention to settle down, medical insurance coverage, and changes in health status, were collected by questionnaire. Results: A change in health status significantly affected the intention to settle down: the more healthy that people became, the more likely they intended to settle down (β = 0.233; p < 0.001), and, simultaneously, changes in health status were also moderated by the length of stay in China (β = 0.320; p < 0.001) and medical insurance (β = 0.134; p < 0.001), which affected people’s willingness to settle down. Conclusions: Changes in health status, and not health status itself, affected immigrants’ willingness to settle down. In addition, social insurance, and the length of stay in the place receiving immigrants, affected immigrants’ willingness to settle down not only directly, but also indirectly by moderating the impact of the change in health status on the willingness to settle down.

Health service utilisation among African migrants in China: a nationwide cross-sectional study

OBJECTIVES

To assess the health utilisation status and associated factors among African migrants in China.

DESIGN

A national cross-sectional study was conducted among African migrants in China in 2019.

SETTING

Participants were recruited online and offline to participate in a self-report survey. Online participants were recruited through WeChat across China, and offline participants were recruited in Guangzhou.

PARTICIPANTS

We recruited participants who were from an African country; had spent at least 1 month cumulatively in China; were at least 18 years old; were willing to provide informed consent. A total of 1025 participants were recruited online and offline, 19 of them were excluded due to invalid response and 1006 people were finally included in the analysis.

OUTCOME MEASURES

The primary outcome was health service utilisation and associated factors among African migrants during their stay in China in the past 12 months. The potential factors include the predisposing factors (demographic characteristics and social structure variables), enabling factors (annual income, health insurance in China) and need factors (non-communicable chronic and infectious diseases, depression) which determined by Anderson framework were measured.

RESULTS

Eight hundred and seven online and 218 offline participants completed the survey, including 624 males and 382 females, with an average age of 26.4±8.9 years. Around 28.5% reported health utilization in the past 12 months. Results showed that longer duration in China, migration to China for business (aOR=2.23, 95% CI:1.13-4.40) and study (aOR=5.00, 95% CI:2.74-9.11), living in apartment (aOR=2.59, 95% CI:1.62-4.14) or dormitory (aOR=3.22, 95% CI:2.17-4.80) in China, suffering from chronic diseases, communicable diseases, and greater depressive symptoms (aOR=1.91, 95% CI:1.42-2.56) facilitated health service utilization.

CONCLUSIONS

The healthcare service that African migrants received in China is low. The existing public health policies and intervention measures need to be improved to make health utilisation more accessible and feasible for African migrants.

Healthcare for migrant workers in destination countries: a comparative qualitative study of China and Malaysia

OBJECTIVES

This paper explores policies addressing migrant worker's health and barriers to healthcare access in two middle-income, destination countries in Asia with cross-border migration to Yunnan province, China and international migration to Malaysia.

DESIGN

Qualitative interviews were conducted in Rui Li City and Tenchong County in Yunnan Province, China (n=23) and Kuala Lumpur, Malaysia (n=44), along with review of policy documents. Data were thematically analysed.

PARTICIPANTS

Participants were migrant workers and key stakeholders with expertise in migrant issues including representatives from international organisations, local civil society organisations, government agencies, medical professionals, academia and trade unions.

RESULTS

Migrant health policies at destination countries were predominantly protectionist, concerned with preventing transmission of communicable disease and the excessive burden on health systems. In China, foreign wives were entitled to state-provided maternal health services while female migrant workers had to pay out-of-pocket and often returned to Myanmar for deliveries. In Malaysia, immigration policies prohibit migrant workers from pregnancy, however, women do deliver at healthcare facilities. Mandatory HIV testing was imposed on migrants in both countries, where it was unclear whether and how informed consent was obtained from migrants. Migrants who did not pass mandatory health screenings in Malaysia would runaway rather than be deported and become undocumented in the process. Excessive attention on migrant workers with communicable disease control campaigns in China resulted in inadvertent stigmatisation. Language and financial barriers frustrated access to care in both countries. Reported conditions of overcrowding and inadequate healthcare access at immigration detention centres raise public health concern.

CONCLUSIONS

This study's findings inform suggestions to mainstream the protection of migrant workers' health within national health policies in two middle-income destination countries, to ensure that health systems are responsive to migrants' needs as well as to strengthen bilateral and regional cooperation towards ensuring better migration management.

Effect of socioeconomic status on the healthcare-seeking behavior of migrant workers in China

In recent years, China has made great efforts to resolve the health inequality caused by household registration restrictions, and the unequal allotment of health services faced by migrant workers has been effectively alleviated. However, inequality in health services may exist not only between migrant workers and local citizens but also among migrant workers. Thus, the unbalanced utilization of health services among migrant workers deserves attention. Using data from the 2017 China Migrants Dynamic Survey (CMDS), we examined the relationship between socioeconomic status (SES) and healthcare-seeking behavior through multivariate regression analysis. Then, from the perspective of SES, this study divided migrant workers into different groups to explore the characteristics of healthcare-seeking behavior in different groups. The results showed that SES had a significant relationship with healthcare-seeking behavior. Those with high SES were more likely to use high-quality health services. By subdividing the category of migrant workers, we found that the utilization of health services among migrant workers was unbalanced. Education and income had significant gradients in multiple measures of healthcare-seeking behavior, while occupation had no significant difference in the behavior. Migrant workers with higher income and education were more likely to use high-quality health services. Especially for migrant workers who had high incomes (above 15,000 CNY) or whose educational backgrounds were graduate level or above, their utilization of health resources was significantly higher than that of other groups. When designing particular policies to improve the healthcare-seeking behavior of different SES migrant workers, we should pay attention to the low-education groups and low-income groups. Policymakers can reduce the current health inequality of migrant workers by strengthening health education and increasing medical subsidies to achieve health equality among migrant workers and between migrant workers and local citizens.

Better Choice, Better Health? Social Integration and Health Inequality among International Migrants in Hangzhou, China

The aim of this study is to investigate the impact of social integration and socioeconomic status on immigrant health in China. Taking the framework of social determinants of health (SDH) as the theoretical starting point, this paper uses the Hangzhou sample of the 2018 Survey of Foreigners in China (SFRC2018) to explore two core factors affecting the health inequality of international migrants in China: the level of social integration following settlement, and socioeconomic status before and after coming to China. The results show that having a formal educational experience in China helped improve both the self-rated health status and self-assessed change in health of international migrants; that the socioeconomic status of an emigrant's home country affected self-rated health; and that the self-assessed change in health of immigrants from developing countries was significantly higher than those from developed countries. This study concludes that the health inequalities of immigrant populations in China must be understood in the context of China's specific healthcare system and treatment structure.