Local-Migrant Gaps in Healthcare Utilization Between Older Migrants and Local Residents in China

Abstract

Background: Older migrants in China without local resident registration (hukou) are a vulnerable population and face barriers to receiving local healthcare.

Objectives: We aimed to quantify the disparities in healthcare utilization between older migrants and local residents in Shanghai, China.

Design: This was a cross-sectional study.

Setting: The study was conducted in Shanghai, China, in 2016.

Participants: Older adults (aged ≥60 years) were recruited based on a three-stage stratified cluster sampling method (2571 older locals and 1920 older migrants).

Measurements: We compared utilization of outpatient care, inpatient care, preventive care, emergency room (ER) admission, and dental care, as well as medication use between older migrants and local residents. The local-migrant gap was parsed into observed and unobserved components using the Blinder-Oaxaca decomposition method.

Results: Older migrants were less likely to utilize outpatient (odds ratio [OR] = 0.757; 95% confidence interval [CI] = 0.617-0.928), inpatient (OR = 0.642; 95% CI = 0.443-0.931), and preventive care (OR = 0.743; 95% CI = 0.643-0.858) and were more likely to use medication (OR = 1.254; 95% CI = 1.089-1.445) than local residents. Differences in ER admissions and dental care utilization were not significant in the regression analysis. The decomposition results indicated that 55% and 71% of the local-migrant gap in outpatient and preventive care utilization were attributable to individual characteristics, like health insurance. Unobserved components, including hukou-related factors and personal heterogeneous preferences, contributed 59% and 63% to utilization of inpatient care and medication use, respectively.

Conclusion: We identified local-migrant gaps in healthcare utilization among older adults in China. Further research is needed into integration of the health insurance system, accessibility of public health welfare benefits, and reconstruction of social networks among older migrants. J Am Geriatr Soc 68:1560-1567, 2020.

Keywords: hukou system; China; Older adults; healthcare utilization; migrants.