Decomposing Differences of Health Service Utilization among Chinese Rural Migrant Workers with New Cooperative Medical Scheme: A Comparative Study

Gender differences in the association between inter-generational interaction and depressive symptoms among Chinese older adults

BACKGROUND

Inter-generational interaction is a carrier of Chinese traditional culture, and it can exert important influence on the depressive symptoms on Chinese older adults. The study aims to analyze gender differences in the association between inter-generational interaction and depressive symptoms among Chinese older adults and explore factors contributing to the differences.

METHOD

Data from China Family Panel Studies in 2020 were used. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression Scale. The latent class analysis was applied to identify patterns of inter-generational interaction of older adults (aged 60 and above). Before the comparison between older man and older woman, we used Coarsened Exact Matching to control confounding factors and improve causal inferences. Multiple linear regression was conducted to explore the association between inter-generational interaction and depression symptoms. Oaxaca-blinder decomposition method was used to analyze the gender difference and the sources.

RESULT

Our study identified three types of inter-generational interaction: detached, nearby but discordant and two-way tight-knit. Analysis indicated that most of older man (54.39%) and older woman (49.78%) were in the type of nearby but discordant. Older man and older woman who in detached type had higher depression scores than other types, and the depression score of two-way tight-knit type accounted for 12.42 and 13.77 respectively. Our findings demonstrated that two-way tight-knit type (-11.89%) significantly decreased the gender differences in the depression symptoms. Other major contributors also included living without spouse (20.56%), primary school and junior middle school (15.95%), higher middle school and above (9.50%) and no illness for two weeks (47.70%).

CONCLUSION

Our study highlighted three patterns of inter-generational interaction, and most of older man and older woman were in the pattern of nearby but discordant. In addition, the two-way tight-knit pattern significantly can decrease gender differences in depression symptoms. The contributors should be taken into account in more targeted intervention strategies for narrowing gender differences in the depression symptoms, which could achieve a gender dividend in the era of China's aging population.

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

BACKGROUND

Accessing health rights is an integral component of people's aspirations for a better life. Existing discussions and evaluations regarding the accessibility of health rights for minority rural migrants are insufficient. In comparison to objective health conditions, inequalities in health rights lead to chronic and long-term depletion of human capital among minority rural migrants. This study aimed to assess the overall impact, heterogeneity effects, and mechanisms of health rights accessibility on the urban integration of minority rural migrants.

METHODS

Based on the 2017 China Migrants Dynamic Survey Data (CMDS), this study employs OLS models, 2SLS models, conditional mixed process (CMP) methods, and omitted variable tests to estimate the impact of health rights accessibility on the urban integration of minority rural migrants. Additionally, from the perspectives of migration scope and illness experience, this study explored the heterogeneity in the relationship between health rights accessibility and urban integration. Finally, using the Karlson-Holm-Breen (KHB) model, this study dissects the mechanisms through which health rights accessibility influences the urban integration of minority rural migrants.

RESULTS

Health rights accessibility significantly enhances the urban integration of minority rural migrants. Moreover, compared to minority rural migrants who move across provinces and who have no history of illness, those who migrate within the same province and who have experienced illness are more sensitive to the positive impact of health rights accessibility. However, the enhancing effect of health rights accessibility does not significantly differ between the new and old generations of minority rural migrants. Furthermore, health rights accessibility can indirectly improve the urban integration of minority rural migrants by elevating health levels, improving health habits, and reinforcing health behaviors. Among these, the indirect effects mediated by health habits are more pronounced.

CONCLUSION

The research conclusions underscore the issue of health accessibility and urban integration among minority rural migrants, providing a reexamination and clarification of the policy effects of health rights in promoting the urban integration of minority rural migrants. Relevant policy design should commence with improving the health rights of minority rural migrants, enhancing their health integration capabilities, and effectively boosting their ability to integrate into urban life.

Inequality of opportunity in health service utilization among middle-aged and elderly community-dwelling adults in China

BACKGROUND

The inequality caused by circumstances is known as "inequality of opportunity" (IOp). Many scholars have studied IOp in the health field, but few studies have quantified contributors to the IOp of health service utilization among middle-aged and elderly people. This study measured the IOp of health service utilization and decomposed the contributors to IOp present among Chinese middle-aged and elderly people.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015 and 2018. A mean-based regression method was adopted to measure the IOp of health service utilization. Shapley-Shorrocks decomposition was used to analyze the main contributors to IOp seen among the middle-aged and elderly.

RESULTS

Although the absolute IOp of health service utilization decreased over time, IOp still explains the total inequality to a large extent. The absolute IOp and relative IOp were greatest in the areas of self-treatment and inpatient care utilization, respectively. Shapley decomposition results showed that the out-of-pocket (OOP) ratio contributed most to the IOp of outpatient care utilization; and the residence area highly explains the IOp of inpatient service utilization. Meanwhile, social and economic factors such as work status and income contribute more to the IOp of inpatient care utilization than outpatient and self-treatment.

CONCLUSIONS

Strategies aimed at achieving equal opportunities remain necessary to ensure the fairness of health service utilization. Policies and measures should further adjust the medical insurance compensation policies, and pay more attention to the middle-aged and elderly residents in rural areas, optimize health resource allocation, improve the social security systems, and narrow the socioeconomic gap between urban and rural areas in China.

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.

By Internal Network or by External Network?-Study on the Social Network Mechanism of Reducing the Perception of Old-Age Support Risks of Rural Elders in China

Nowadays, it is a general trend for China to enter a deep aging society, and the aging situation of the rural population is particularly severe. As informal endogenous resources in rural areas, social networks play an essential role in ensuring elders' later life. Data were drawn from a questionnaire survey of 1126 rural elders in 11 provinces of China. Descriptive statistics and an ordinary least square regression model were conducted to explore the impact of social networks on the perception of old-age support risks of rural elders. There was a significant positive association between the social network size and the reduction in perception of old-age support risks of rural elders. The reduction effect was mainly reflected in the internal network size, whereas it was not evident in the external network size. There was a significant positive association between the heterogeneity of the network and the perceived level of old-age support risks of rural elders. There was a significant positive association between the communication frequency of external network relationships and the perceived level of old-age support risks of rural elders. We found a significant negative association between the ratio of communication frequency between the internal and external network relationships and the perception of old-age support risks of rural elders. Compared with the external network, the internal network had a more evident reduction effect on the social network mechanism of perception of old-age support risks of rural elders.

Occupational Dust Exposure and Respiratory Protection of Migrant Interior Construction Workers in Two Chinese Cities

Migrant interior construction workers are increasing in China. Construction workers are at an increased risk of work-related illness (WRI) due to prolonged exposure to and inhalation of dust. Dust concentrations in the air can be reduced significantly with effective respiratory protection measures. We assessed the dust exposure and factors associated with respiratory protection of migrant interior construction workers. The total dust concentration in the workplace ranged from 0.07 to 335.27 mg/m³, with a total dust exceedance rate of 50.00%. The respiratory dust loading ranged from 0.03 to 220.27 mg/m³, with a respiratory dust exceedance rate of 71.42 %. The highest total dust concentration occurred when masons were polishing cement walls. We performed a questionnaire survey of 296 persons in two cities in China, in which 87.84% had no respiratory protection or only one protection measure. Gender, workplace, respiratory disease, and protective attitude all had an effect on the level of respiratory protection. The dust exposure in most jobs exceeds hygiene standards. The respiratory protection of migrant interior construction workers in China is inadequate.

Health status and public health education for internal older migrants in China: Evidence from a nationally representative survey

Background

Self-rated health has been widely used as a useful screening tool to subjectively evaluate individuals' health status. Under the context of the rapid growth of aging, there was a dramatic rapid expansion in internal older migrants in China. Serious concerns on the issues of health status continue to attract quite a lot of attention over the past decades. Public health education is one of the most important health care services and methods to improve individuals' health status. However, most previous studies focus on the utilization of public health services such as visiting to doctors, physical examination, and hospitalization. There was limited evidence on the self-rated health and public health education of older migrants.

Objectives

The study aimed to evaluate self-rated health and the associated determinants in older migrants, as well as to gain a deeper insight into the current status of public health education received by older migrants.

Methods

We derived the data from the National Migrants Population Health and Family Planning Dynamic Monitor Survey 2018, a cross-sectional study, for secondary analysis. Internal migrants aged 60 years old or over were included in the study. Self-rated health was the dependent variable, while sociodemographic characteristics were the independent variable. The univariate and multivariate analyses were performed by Stata 15.1.

Results

A total of 5,589 older migrants were included in the study. Eighty-two percentage of older migrants reported healthy self-rated health. There was a significant association between age, gender, minzu, education level, monthly income, public health education, and self-rated health (P < 0.5). However, the proportion of older migrants that received specific public health education was <50%. The most common approach to receiving public health education was through the leaflet, while <20% of older migrants received public health education through public consultation and one-to-one education.

Conclusions

It was necessary to promote the publicity of public health education in older migrants through easy access and diverse approaches in order to effectively spread health-related knowledge to older migrants to satisfy their health needs and maintain their health.

Socio-economic inequalities in health service utilization among Chinese rural migrant workers with New Cooperative Medical Scheme: a multilevel regression approach

Background

While reducing inequity in health service utilization is an important goal of China’s health system, it has been widely acknowledged that a huge number of rural migrant workers cannot be effectually protected against risks with the New Rural Cooperative Medical Insurance (NCMS).

Method

Data of the 2016 China Labor-force Dynamic Survey and the Chinese Urban Statistical Yearbook were used. The multilevel regression approach was implemented with a nationally representative sample of rural migrant workers with NCMS. Our study adopted the concentration index and its decomposition method to quantify the inequality of their health service utilization.

Result

The multilevel model analysis indicated that impact variables for health service utilization were not concentrated, especially the contextual and individual characteristics. The concentration indices of the probability of two weeks outpatient and the probability of inpatient were -0.168 (95%CI:-0.236,-0.092) and -0.072 (95%CI:-1.085,-0.060), respectively. The horizontal inequality indices for the probability of two-week outpatient and the probability of inpatient were -0.012 and 0.053, respectively.

Conclusion

The health service utilization of rural migrant workers with NCMS is insufficient. Our study highlighted that substantial inequalities in their health service utilization did exist. In addition, their need of health service utilization increased the pro-poor inequality. Based on the findings, our study offered notable implications on compensation policies and benefit packages to improve the equality among rural migrant workers with NCMS.

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

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.

Assessing Income-Related Inequality on Health Service Utilization among Chinese Rural Migrant Workers with New Co-Operative Medical Scheme: A Multilevel Approach

Background: Eliminating inequality in health service utilization is an explicit goal of China’s health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems—particularly for some marginal groups in China.