Le Anh Thi Kim, Vu Lan Hoang, Schelling Esther
Department of Epidemiology and Biostatistics, Hanoi School of Public Health, Viet Nam.
Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.
Tap Chi Y Te Cong Cong. 2015 Dec;3(2):44-56.
Economic transition () in the 1980s in Viet Nam has led to internal migration, particularly rural-to-urban migration. Many studies suggested that there is a difference between non-migrants and migrants in using health care services. Current studies have mostly focused on migrants working in industrial zones (IZs) but migrants working in private small enterprises (PSEs) and seasonal migrants seem to be ignored. However, these two groups of migrants are more vulnerable in health care access than others because they usually work without labor contracts and have no health insurance. The study aims to compare the utilization of health care services and explore its correlated factors among these three groups.
This cross-sectional study included 1800 non-migrants and migrants aged 18-55 who were selected through stratified sampling in Long Bien and Ba Dinh districts, Hanoi. These study sites consist of large industrial zones and many slums where most seasonal migrants live in. A structured questionnaire was used to collect information on health service utilization in the last 6 months before the study. Utilization of heath care services was identified as "an ill person who goes to health care centers to seek any treatment (i.e. both private and public health care centers)".
644 of 1800 participants reported having a health problem in the last 6 months before the study. Among these 644 people, 335 people used health care services. The percentage of non-migrants using health care service was the highest (67.6%), followed by migrants working in IZ (53.7%), migrants working in PSE (44%), and seasonal migrants (42%). Multivariate logistic regression showed migrants, especially seasonal migrants and migrants working in PSE, were less likely to use health care services (OR=0.35, p=0.016 and 0.38, p= 0.004, respectively), compared to non-migrants. The study also found that having no health insurance was a risk factor of the utilization (OR=0.29, p<0.001). Other factors such as gender, age, marital status, socioeconomic status, and monthly income were not related to the utilization of health care services.
Seasonal migrants have the worst utilization of health care services, followed by migrants working in PSE, migrants working in IZ, and non-migrants. Health insurance is an important factor relating to the utilization. Accordingly, health insurance coverage needs to be increased if utilization of health care services for the whole population, particularly migrant population, is to be improved.
20世纪80年代越南的经济转型导致了国内人口迁移，尤其是从农村到城市的迁移。许多研究表明，非移民和移民在使用医疗服务方面存在差异。目前的研究大多集中在工业区工作的移民，但在私营小企业工作的移民和季节性移民似乎被忽视了。然而，这两类移民在获得医疗服务方面比其他人更脆弱，因为他们通常没有劳动合同且没有医疗保险。本研究旨在比较这三组人群的医疗服务利用情况并探索其相关因素。
这项横断面研究纳入了1800名年龄在18 - 55岁之间的非移民和移民，他们是通过在河内龙边和巴亭区进行分层抽样选取的。这些研究地点包括大型工业区和许多季节性移民居住的贫民窟。使用结构化问卷收集研究前最后6个月内的医疗服务利用信息。医疗服务利用被定义为“前往医疗中心寻求任何治疗的患病者（即包括私立和公立医疗中心）”。
1800名参与者中有644人报告在研究前的最后6个月内有健康问题。在这644人中，335人使用了医疗服务。非移民使用医疗服务的比例最高（67.6%），其次是在工业区工作的移民（53.7%）、在私营小企业工作的移民（44%）和季节性移民（42%）。多因素逻辑回归显示，与非移民相比，移民，尤其是季节性移民和在私营小企业工作的移民使用医疗服务的可能性较小（OR分别为0.35，p = 0.016和0.38，p = 0.004）。研究还发现没有医疗保险是医疗服务利用的一个风险因素（OR = 0.29，p < 0.001）。其他因素，如性别、年龄、婚姻状况、社会经济地位和月收入，与医疗服务利用无关。
季节性移民的医疗服务利用情况最差，其次是在私营小企业工作的移民、在工业区工作的移民和非移民。医疗保险是与医疗服务利用相关的一个重要因素。因此，如果要提高全体人口，特别是移民人口的医疗服务利用水平，就需要扩大医疗保险覆盖范围。
