社区卫生中心能否改善移民的自评健康状况？来自中国的证据。

Can community health centers improve the self-rated health of migrants? Evidence from China.

机构信息

School of Labor Economics, Capital University of Economics and Business, Beijing, China.

出版信息

Front Public Health. 2022 Sep 23;10:986201. doi: 10.3389/fpubh.2022.986201. eCollection 2022.

DOI:10.3389/fpubh.2022.986201

PMID:36211663

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9541740/

Abstract

BACKGROUND

Due to the "epidemiological paradox," migrants face the risk of health attrition during their migration. Meanwhile, institutional constraints cause a health gap between migrants and non-migrants. To narrow this gap and maintain equity, scholars have studied the role and impact mechanism of medical insurance participation in improving the health of migrants. However, due to the provision of China's basic medical insurance system, the proportion of migrants participating in employee medical insurance is still relatively low, while the community health center (CHC) is a more accessible medical resource for this group. Therefore, this study attempts to explore the impact of CHCs on the self-rated health (SRH) of migrants and identify the factors and mechanisms associated with such an impact. This study addresses the hypotheses whether (a) CHCs can significantly improve the SRH of migrants in China and (b) CHCs improve the SRH of migrants by promoting both their health knowledge and health behavior.

METHODS

Data was obtained from the 2017 China Migrants Dynamic Survey (CMDS). From the survey, 127,687 migrants were identified, and a series of logit regressions were conducted to explore the correlation between CHCs and the SRH of migrants. Propensity score matching (PSM) logit was also used for the robustness tests.

RESULTS

Logit estimations revealed that CHC is positively related to the SRH of migrants (OR = 1.095, < 0.001). Compared to others, males (OR = 1.156, < 0.001), younger people with higher education (OR = 1.027, < 0.001), more stable employment (OR = 1.544, < 0.001), and people with a lower proportion of elderly (> 65 years) household family members (OR = 0.842, < 0.001) tended to have better SRH. The results also showed that the impact of CHCs on migrants' SRH varied by gender, age, and income ( < 0.001). A possible mechanism is that CHCs can improve migrants' SRH by promoting both their health knowledge and health behaviors.

CONCLUSION

Programs that strengthen health knowledge and policies to enhance access to healthcare could be prioritized to improve the SRH of migrants in China.

摘要

背景

由于“流行病学悖论”，移民在迁移过程中面临健康损耗的风险。同时，制度限制导致移民和非移民之间存在健康差距。为了缩小这一差距并维护公平，学者们研究了医疗保险参与改善移民健康的作用和影响机制。然而，由于中国基本医疗保险制度的规定，移民中参加职工医疗保险的比例仍然相对较低，而社区卫生服务中心（CHC）是这群人更容易获得的医疗资源。因此，本研究试图探讨 CHC 对移民自评健康（SRH）的影响，并确定与这种影响相关的因素和机制。本研究提出了以下假设：（a）CHC 能否显著提高中国移民的 SRH；（b）CHC 是否通过促进健康知识和健康行为来提高移民的 SRH。

方法

数据来自 2017 年中国流动人口动态监测调查（CMDS）。从调查中确定了 127687 名移民，并进行了一系列逻辑回归以探讨 CHC 与移民 SRH 之间的相关性。还使用倾向得分匹配（PSM）逻辑回归进行稳健性检验。

结果

逻辑回归估计显示，CHC 与移民的 SRH 呈正相关（OR=1.095，<0.001）。与其他人相比，男性（OR=1.156，<0.001）、受教育程度较高的年轻人（OR=1.027，<0.001）、就业更稳定的人（OR=1.544，<0.001）和老年（>65 岁）家庭成员比例较低的家庭（OR=0.842，<0.001）的人往往具有更好的 SRH。结果还表明，CHC 对移民 SRH 的影响因性别、年龄和收入而异（<0.001）。一种可能的机制是，CHC 可以通过提高健康知识和促进健康行为来改善移民的 SRH。