社会资本、性别和教育对公共卫生服务利用的影响：基于中国流动人口动态监测调查的横断面研究。
Impact of social capital, sex and education on the utilization of public health services: a cross sectional study based on the China migrant dynamic survey.
机构信息
School of Medicine, Tongji University, No 1239 Siping Road, Yangpu District, Shanghai, 200092, China.
School of Medicine, Jinggangshan University, Jianan, 343009, Jiangxi, China.
出版信息
BMC Public Health. 2021 Apr 19;21(1):751. doi: 10.1186/s12889-021-10803-y.
BACKGROUND
China is making efforts to promote the equalization of National Essential Public Health Services (NEPHS) for internal migrants. Studies have demonstrated that the impacts of social capital on health services are different among subgroups of people. Clarifying these differences will help China accurately promote the equalization of NEPHS for the internal migrants and provide reference for other countries.
METHODS
Data from the China Migrant Dynamic Survey of 2017, involving 130,642 migrants in 31 provinces were used to clarify the complex relationship between social capital and the utilization of NEPHS. Social capital was divided into regional cognitive social capital (RCSC), regional structural social capital (RSSC), individual cognitive social capital (ICSC), and individual structural social capital (ISSC). Then, multi-level logistic regression was conducted to analyze their impacts on the utilization of NEPHS of the migrants, and whether such impacts are moderated by sex and education.
RESULTS
(1) There are significant differences in the levels of CSC, SSC, and NEPHS utilization between different sexs and educational subgroups of the migrants, among which the educational difference is more prominent. (2) An interaction exists between the levels and dimensions of social capital and NEPHS projects. Also, the impact of SSC on NEPHS is always greater than that of CSC at the same level. (3) The effects of RCSC, RSSC, ICSC, and ISSC on NEPHS utilization by migrants are not moderated by sex. However, a high education could weaken the relationship between RCSC and health education, ISSC and health education, and RSSC and health records but strengthen the correlation between RSSC and health education.
CONCLUSION
Social capital plays an important role in the access of migrants to NEPHS. Governments should vigorously promote the construction of regional social capital, encourage migrants to actively participate in community activities, especially pay attention to the enhancement of the migrants with low SES to the destination identity.
背景
中国正在努力促进流动人口的国家基本公共卫生服务均等化。研究表明，社会资本对卫生服务的影响在人群亚组中存在差异。明确这些差异将有助于中国准确地促进流动人口的基本公共卫生服务均等化，并为其他国家提供参考。
方法
本研究利用 2017 年中国流动人口动态监测调查的数据，对全国 31 个省份的 130642 名流动人口进行分析，以阐明社会资本与基本公共卫生服务利用之间的复杂关系。社会资本分为区域认知社会资本（RCSC）、区域结构社会资本（RSSC）、个体认知社会资本（ICSC）和个体结构社会资本（ISSC）。然后，采用多水平逻辑回归分析方法，探讨社会资本及其各维度对流动人口基本公共卫生服务利用的影响，并检验性别的调节作用。
结果
（1）不同性别和教育程度流动人口的社会资本、社会资本各维度以及基本公共卫生服务利用水平存在显著差异，其中教育程度的差异更为显著。（2）社会资本的水平和维度与基本公共卫生服务项目之间存在交互作用，且在同一水平上，社会资本对基本公共卫生服务利用的影响始终大于认知社会资本。（3）RCSC、RSSC、ICSC 和 ISSC 对流动人口基本公共卫生服务利用的影响不受性别的调节，但高教育程度可以削弱 RCSC 与健康教育、ISSC 与健康教育以及 RSSC 与健康记录的关系，同时可以增强 RSSC 与健康教育的相关性。
结论
社会资本在流动人口获得基本公共卫生服务方面发挥着重要作用。政府应大力推进区域社会资本建设，鼓励流动人口积极参与社区活动，特别是要关注社会经济地位较低的流动人口对目的地身份的认同感的提升。
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