Office of Health Emergency, Ministry of Health, Beijing 100044, China.
BMC Health Serv Res. 2010 Mar 19;10:69. doi: 10.1186/1472-6963-10-69.
Migrant workers are a unique phenomenon in the process of China's economic transformation. The household registration system classifies them as temporary residents in cities, putting them in a vulnerable state with an unfair share of urban infrastructure and social public welfare. The amount of pressure inflicted by migrant workers in Beijing, as one of the major migration destinations, is currently at a threshold. This study was designed to assess the factors associated with health-seeking behavior and to explore feasible solutions to the obstacles migrant workers in China faced with when accessing health-care.
A sample of 2,478 migrant workers in Beijing was chosen by the multi-stage stratified cluster sampling method. A structured questionnaire survey was conducted via face-to-face interviews between investigators and subjects. The multilevel methodology (MLM) was used to demonstrate the independent effects of the explanatory variables on health seeking behavior in migrant workers.
The medical visitation rate of migrant workers within the past two weeks was 4.8%, which only accounted for 36.4% of those who were ill. Nearly one-third of the migrant workers chose self-medication (33.3%) or no measures (30.3%) while ill within the past two weeks. 19.7% of the sick migrants who should have been hospitalized failed to receive medical treatment within the past year. According to self-reported reasons, the high cost of health service was a significant obstacle to health-care access for 40.5% of the migrant workers who became sick. However, 94.0% of the migrant workers didn't have any insurance coverage in Beijing. The multilevel model analysis indicates that health-seeking behavior among migrants is significantly associated with their insurance coverage. Meanwhile, such factors as household monthly income per capita and working hours per day also affect the medical visitation rate of the migrant workers in Beijing.
This study assesses the influence of socio-demographic characteristics on the migrant workers' decision to seek health care services when they fall ill, and it also indicates that the current health service system discourages migrant workers from seeking appropriate care of good quality. Relevant policies of public medical insurance and assistance program should be vigorously implemented for providing affordable health care services to the migrants. Feasible measures need to be taken to reduce the health risks associated with current hygiene practices and equity should be assured in access to health care services among migrant workers.
农民工是中国经济转型过程中的一个独特现象。户籍制度将他们归类为城市的临时居民，使他们处于弱势地位，无法公平享受到城市基础设施和社会公共福利。作为主要移民目的地之一的北京，农民工所承受的压力目前已经达到了一个临界点。本研究旨在评估与寻求健康行为相关的因素，并探讨解决中国农民工在获得医疗保健方面面临的障碍的可行方法。
采用多阶段分层聚类抽样法，选取北京市 2478 名农民工作为样本。通过调查员与被调查者面对面访谈，进行了结构化问卷调查。采用多层次方法（MLM）来展示解释变量对农民工寻求健康行为的独立影响。
在过去两周内，农民工的就医率为 4.8%，仅占患病者的 36.4%。在过去两周内生病的农民工中，近三分之一选择了自我药疗（33.3%）或不采取任何措施（30.3%）。在过去一年中，应该住院治疗的 19.7%的患病移民没有得到治疗。根据自我报告的原因，40.5%生病的农民工认为医疗服务费用高是获得医疗保健的一个重大障碍。然而，94.0%的农民工在北京没有任何保险。多层次模型分析表明，农民工的就医行为与他们的保险覆盖范围显著相关。同时，人均家庭月收入和每天工作时间等因素也影响了北京市农民工的就医率。
本研究评估了社会人口特征对农民工患病时寻求医疗服务决策的影响，同时表明，当前的医疗服务体系阻碍了农民工寻求适当的高质量医疗服务。应大力实施公共医疗保险和援助计划相关政策，为农民工提供负担得起的医疗保健服务。需要采取可行措施，减少当前卫生习惯带来的健康风险，并确保农民工公平获得医疗服务。
