School of Health Management, Inner Mongolia Medical University, Hohhot, 010100, China.
Sci Rep. 2024 Nov 27;14(1):29510. doi: 10.1038/s41598-024-81068-9.
This study investigates the impact of the family doctor contracted service system on the health of migrants in China, utilizing data from the 2018 China Migrants Dynamic Survey (CMDS). The study employs a double machine learning model to estimate the effect of family doctor contracted services (FDCS) on migrants' self-rated health (MSRH). The sample consists of 137,851 migrants, with family doctor service contract status, health education, and health records as key variables. To address potential endogeneity issues, an instrumental variable approach using the regional family doctor contracting rate was implemented. Mediation analysis was conducted to examine the roles of health education and health records in this relationship. The findings indicate that FDCS significantly improve MSRH. This positive effect is robust across various machine learning models, including Lassocv, Random Forest, and Gradient Boost. The instrumental variable approach confirms the validity of these results, mitigating concerns about endogeneity. Mediation analysis reveals that the positive impact of FDCS on MSRH is fully mediated by health education and health records, highlighting their critical roles in enhancing health outcomes. The FDCS play a crucial role in improving the health of migrants by providing continuous and comprehensive care. Enhanced health education and effective health records management are significant pathways through which these services exert their positive effects. Policy recommendations include expanding access to family doctor services, enhancing health education programs, and improving health records management to optimize healthcare delivery for migrants. Future research should consider longitudinal studies to further validate these findings and explore their applicability to specific subgroups or regions.
本研究利用 2018 年中国流动人口动态监测调查(CMDS)的数据,考察了家庭医生签约服务制度对中国流动人口健康的影响。研究采用双重机器学习模型估计家庭医生签约服务(FDCS)对流动人口自评健康(MSRH)的影响。样本包括 137851 名流动人口,关键变量包括家庭医生服务合同状况、健康教育和健康记录。为了解决潜在的内生性问题,采用了区域家庭医生签约率的工具变量方法。进行了中介分析,以检验健康教育和健康记录在这种关系中的作用。研究结果表明,FDCS 显著改善了 MSRH。这种积极影响在各种机器学习模型中都是稳健的,包括 Lassocv、Random Forest 和 Gradient Boost。工具变量方法证实了这些结果的有效性,减轻了内生性问题的担忧。中介分析表明,FDCS 对 MSRH 的积极影响完全通过健康教育和健康记录来介导,突出了它们在改善健康结果方面的关键作用。FDCS 通过提供连续和全面的护理,在改善移民健康方面发挥着关键作用。强化健康教育和有效的健康记录管理是这些服务发挥积极作用的重要途径。政策建议包括扩大家庭医生服务的获取途径,加强健康教育计划,并改善健康记录管理,以优化移民的医疗服务提供。未来的研究应考虑进行纵向研究,以进一步验证这些发现,并探索其在特定亚组或地区的适用性。