Abstract
International immigrants’ health is receiving increasing attention, reflecting the need for health systems to adapt to diverse migrant populations. To better inform health policies suited for the needs of international immigrants living in China, empirical evidence on the health service utilization of these international immigrants living in China is urgently needed. Our study included 5459 international immigrants including inpatients and outpatients, who were treated over a 4-year period (2015–2018) in one of the most frequented hospitals by international immigrants in Yiwu, Zhejiang province. Data (e.g., demographic information, outpatient costs, inpatient costs, length of stay, and the average number of visits per patient) were extracted from the Health Information System at the hospital. Descriptive analysis was performed to analyze the basic characteristics of international immigrants living in China (e.g., medical costs, length of stay and the average number of visits per patient) during the study period. Multiple regression analysis was conducted to assess the factors that influence the health service utilization of international immigrants. International immigrants tended to use outpatient services (accounting for 97.22% of the whole sample) compared with inpatient services (only 2.78% of the whole sample). Most international immigrants visited the hospital because of orthopedics, otolaryngological diseases, pediatric-related diseases and skin-related diseases, followed by maternity and general surgery. The average number of visits to the outpatient department per patient was 2.1 in 2015 to 2.5 in 2018, and the length of stay increased from 3.45 days to 5.81 days during last four years. The outpatient costs increased from RMB 800.43(112.22 US$) to RMB 1756.98(246.33 US$), and inpatient costs rose from RMB 10,958.89(1536.44US$) to RMB 20,912.55(2931.94US$) during 2015–2018. The average number of visits and outpatient costs of international immigrants were both lower than those of local Chinese people (P < 0.05). However, there was no statistic difference in inpatient costs and LOS between international immigrants and Chinese. Having health insurance in China was significantly related with higher medical costs. Our results indicate that international immigrants living in China make greater use of outpatient services rather than hospitalization health services. Health services utilization is increasing in the last four years, but it was lower than that of local Chinese people especially outpatient service utilization. Moreover, more attention should be garnered toward specific health issues experienced by international immigrants, such as orthopedic health, maternal and child health, occupational diseases or accidents, and infectious diseases with skin-related symptoms. The policy implications from the results of this study are as follows. First, in order to improve international immigrants’ health and access to health services in China, the government needs to pay more attention to incorporating international immigrants’ health services to the current health system. Second, health policy is an important determining factor of access to health care, as policy can influence aspects of health services delivery such as the availability of resources, organization, and financing. Therefore, specific framework for the content of health policies focused on international immigrant populations should be developed.
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References
Clark J. World leaders adopt first global pact on migration. Lancet. 2018;392(10165):e17.
2018 United Nations Migration Report. https://publications.iom.int/books/world-migration-report-2018. Accessed 31 July 2020.
National Immigration Administration. https://www.nia.gov.cn/. Accessed 31 July 2020.
Kwak K. An evaluation of the healthy immigrant effect with adolescents in Canada: examinations of gender and length of residence. Soc Sci Med. 2016;157:87–95.
Lu Y, Qin L. Healthy migrant and salmon bias hypotheses: a study of health and internal migration in China. Soc Sci Med. 2014;102(2):41–8.
Halliday T, Kimmitt M. Selective migration and health in the USA. Popul Stud. 2008;62:321–34.
Markides K, Eschbach K. Hispanic paradox in adult mortality in the United States. Int Handb Popul. 2011;2:227–40.
Riosmena F, Dennis J. Aging, health and longevity in the Mexican-origin population. New York: Springer Press; 2012.
Rubalcava LN, Teruel GM, Thomas D, Goldman N. The healthy migrant effect: new findings from the Mexican family life survey. Am J Public Health. 2008;98:78–84.
Constant AF, García-Muñoz T, Neuman S, Neuman T. A “healthy immigrant effect” or a “sick immigrant effect”? Selection and policies matter. Eur J Health Econom. 2018;19(1):103–21.
Bollini P, Siem H. No real progress towards equity: Health of migrants and ethnic minorities on the eve of the year 2000. Soc Sci Med. 1995;41(6):819–28.
Kennedy S, Kidd MP, McDonald JT, Biddle N. The healthy immigrant effect: patterns and evidence from four countries. J Int Migr Integr. 2015;16:317–32.
Antecol H, Bedard K. Unhealthy assimilation: why do immigrants converge to American health status levels? Demography. 2006;43:337–60.
Hernández-Quevedo C, Jiménez-Rubio D. A comparison of the health status and health care utilisation patterns between foreigners and the national population in Spain: new evidence from the Spanish national health survey. Soc Sci Med. 2009;69:370–8.
Cots F, Castells X, Garcıá O, Riu M, Felipe A, Vall O. Impact of immigration on the cost of emergency visits in Barcelona (Spain). BMC Health Serv Res. 2007;7:9–17.
Norredam M, Krasnik A. Migrants access to health services. In: Mladovsky P, Devillé W, Rijks B, Pretova-Benedict R, McKee M, editors. Migration and health in the European Union. Maidenhead: Open University Press McGraw Hill; 2011. p. 67–78.
Rechel B, Mladovsky P, Ingleby D, Mackenbach JP, McKee M. Migration and health in an increasingly diverse Europe. Lancet. 2013;381:1235–45.
Biswas D, Kristiansen M, Krasnik A, Norredam M. Access to health-care and alternative health-seeking strategies among undocumented migrants in Denmark. BMC Public Health. 2011;11:560.
Deville W, Greacen T, Bogic M, Dauvrin M, Dias S, Gaddini A, et al. Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study. BMC Public Health. 2011;11:699.
Jensen NK, Norredam M, Draebel T, Bogic M, Priebe S, Krasnik A. Pro-viding medical care for undocumented migrants in Denmark: what are the challenges for health professionals? BMC Health Serv Res. 2011;11:154.
Dauvrin M, Lorant V, Sandhu S, Deville W, Dia H, Dias S, et al. Healthcare for irregular migrants: pragmatism across Europe: a qualitative study. BMC Res Notes. 2012;5:99.
Woodward A, Howard N, Wolffers I. Health and access to care for undocumented migrants living in the European Union: a scoping review. Health Policy Plan. 2014;29:818–30.
MaríaLuisa V, Vargas I, Daniel LJ, et al. Was access to health care easy for immigrants in Spain? The perspectives of health personnel in Catalonia and Andalusia. Health Policy. 2016;120(4):396–405.
Malmusi D, Ortiz-Barreda G. Health inequalities in immigrant populations in Spain: a scoping review. Rev Espanola de Salud Pública. 2014;88:687–701.
Hyman I. Immigration and Health: Reviewing Evidence of the Healthy Immigrant Effect in Canada. https://publications.gc.ca/collections/Collection/H135–01–5E.pdf. Accessed 31 July 2020.
Vázquez ML, Terraza-Núnez R, Hernández S, Silvia VL, Bosch L, González A, et al. Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies. Health Policy. 2013;113:236–46.
Tang K, Li Z, Li W, Chen L. China's silk road and global health. Lancet. 2017;390(10112):2595.
Wu X, Ramesh M, Howlett M, Gu QY. Local government entrepreneurship and global competitiveness: a case study of Yiwu Market in China. Soc Sci Electron Publish. 2017;14(3):51–66.
Xu JF, Wang J, Wimo A, Cheng XQ. The economic burden of mental disorders in China, 2005–2013: implications for health policy. BMC Psychiatry. 2016;16(1):1–9.
Xu JF, Wang J, Liu RY, Xing J, Su L, Yu F, et al. Mental health patient treatment expenditure trends in China, 2005–2012: evidence from Shandong. J Mental Health Policy Econ. 2014;17(4):173–82.
Credé SH, Such E, Mason S. International migrants' use of emergency departments in Europe compared with non-migrants' use: a systematic review. Eur J Public Health. 2018;28(1):61–73.
Derose KP, Bahney BW, Lurie N, Escarce JJ. Review: immigrants and health care access, quality, and cost. Med Care Res Rev. 2009;66:355–408.
Beckman A, Merlo J, Lynch JW. Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmo. Sweden J Epidemiol Community Health. 2004;58:145–9.
Hjern A, Haglund B, Persson G, Rosen M. Is there equity in access to health services for ethnic minorities in Sweden? Eur J Public Health. 2001;11:147–52.
Javdan B, Cassileth B. Cancer care among immigrants to North America. Cancer care in countries and societies in transition. Berlin: Springer; 2016.
Garcıá-Gómez P, López-Nicolás A. The evolution of inequity in the access to health care in Spain: 1987–2001 Documento de Trabajo No. 10. Bilbao: Fundación BBVA; 2007.
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This work was supported by the National Natural Science Foundation of China (Project No. 71904171) and “the Fundamental Research Funds for the Central Universities.
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The study protocol and consent were approved by Institutional Review Board for Human Subject Research, School of Medicine, Zhejiang University (2019-064).
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Xu, J., Chen, X., Liu, K. et al. Health Service Utilization of International Immigrants in Yiwu, China: Implication for Health Policy. J Immigrant Minority Health 23, 207–214 (2021). https://doi.org/10.1007/s10903-020-01066-7
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DOI: https://doi.org/10.1007/s10903-020-01066-7