Increasing access to healthcare for migrant workers: Shenzhen case study

Background: In China's rapid social and economic transition, cities such as Shenzhen have seen substantive increase of migrant population. Setting priorities for health services in this population challenges the government.

Objectives: This study compares self-reported health (SRH) and healthcare utilization of insured and uninsured migrant workers in Shenzhen.

Methods: Multi-staged sampling was used to draw samples from 120 legally registered enterprises. A cross-sectional survey was conducted to collect data from factory workers in their workplaces. Results: Among 4634 subjects who responded, over half were uninsured. The uninsured were more likely to be female, single, younger and less educated unskilled laborers with a lower monthly income compared with the insured, who were more likely to have reported sickness in previous two weeks and visited a doctor when sick, although disease patterns were similar despite insurance status. Out of 1136 reporting illness in previous two weeks, around two thirds did not visit a doctor. Those who were referred to hospitals for admissions, half did not attend citing inability to pay as main reason. Multivariate logistic regression analyses suggested that being insured, good SRH, and having convenient accessibility to primary care facilities would have increased the likelihood of doctor visits.

Conclusions: The health insurance system is inequitably distributed amongst migrant workers. Being insured and having convenient accessibility to primary care were helpful for getting outpatient services. Inability to pay and high uninsured rate suggested further needs for continuing reform and evaluation of health insurance systems for migrants.