Chinese Hukou Policy and Rural-to-Urban Migrants’ Health: Evidence from Matching Methods

  • Marta BengoaEmail author
  • Christopher Rick
Urban Symposium Paper


Internal migration and the provision of social benefits in China are restricted by the institutional policy, commonly called hukou. Hukou status is mainly determined by place of origin. It creates a two-tier system that exacerbates inequality across Chinese households—rural versus urban hukou. We apply coarsened exact matching methods and propensity score models to estimate the impact of obtaining an urban hukou on rural-to-urban migrants’ health outcomes. Our results indicate that migrants with urban hukou maintain lower levels of blood pressure and are less likely to develop hypertension or nutritional conditions compared to rural hukou migrants. We do not find significant results on self-rated health. Our findings show that, in the short-medium term, there are differences in health that are prevalent for migrants with different hukous.


Internal migration Hukou registration system Health outcomes 

JEL Classification

F22 I15 I18 



We would like to thank the Institute for the Study of Labor (IZA) for providing access to the Rural Urban Migration data survey. We are very grateful to the two anonymous reviewers and the guest editor who provided valuable comments leading to the improvement in the manuscript. We would also like to acknowledge the insightful comments and suggestions by Hillel Rapoport, David McKenzie, Isabel Ruiz-Olaya, Jason Barr, Daniel Maxwell, Joseph Pelzman, Sara Tonini, Balding, Yue Li and Ramya Shankar. We are also grateful to participants at various conferences and seminars where the paper was presented including the Paris School of Economics Migration workshop, the WIDER Conference on ‘Migration and Mobility,’ the International Trade and Finance Association Meeting, Western Economic Association Meeting, ASSA meeting, Eastern Economic Association annual meeting, and seminars at the City University of New York, Cape Town University, and University of Johannesburg. Excellent research assistance has been provided by David Dam. All errors remain our own.


  1. Aizer, Anna, Shari Eli, Ferrie Joseph, and Adriana Lleras-Muney. 2016. The long-run impact of cash transfers to poor families. American Economic Review 106(4): 935–971.CrossRefGoogle Scholar
  2. Akgüç, Mehtap, Corrado Giulietti, and Klaus F. Zimmermann. 2014a. The RUMiC longitudinal survey: fostering research on labour markets in China. IZA Journal of Labor Development 3: 5.CrossRefGoogle Scholar
  3. Akgüç, Mehtap, Xingfei Liu, and Massimiliano Tani. 2014b. Expropriation with hukou change: Evidence from a quasi-natural experiment (No. 8689). IZA Discussion Papers. Bonn: Institute for the Study of Labour.Google Scholar
  4. Becker, Sascha O., and Andrea Ichino. 2002. Estimation of the average treatment effect based on propensity scores. Stata Journal 2: 358–377.CrossRefGoogle Scholar
  5. Blackwell, Matthew, Stefano Iacus, Gary King, and Giuseppe Porro. 2009. Coarsened exact matching in stata. The Stata Journal 4: 524–546.CrossRefGoogle Scholar
  6. Caliendo, Marco, and Sabine Kopeinig. 2008. Some practical guidance for the implementation of propensity score matching. Journal of Economic Surveys 22(1): 31–72.CrossRefGoogle Scholar
  7. Card, David, Carlos Dobkin, and Nicole Maestas. 2008. The impact of nearly universal insurance coverage on health care utilization: Evidence from medicare. American Economic Review 98(5): 2242–2258.CrossRefGoogle Scholar
  8. Cardella, Eric, and Briggs Depew. 2014. The effect of health insurance coverage on the reported health of young adults. Economics Letters 124(3): 406–410.CrossRefGoogle Scholar
  9. Chan, Kam W., and Will Buckingham. 2008. Is China abolishing the hukou system? The China Quarterly 195: 582–606.CrossRefGoogle Scholar
  10. Doytch, Nadia, Dhaval M. Dave, and Rashad Kelly. 2016. Global evidence on obesity and related outcomes: An overview of prevalence, trends, and determinants. Eastern Economic Journal 42(1): 7–28.CrossRefGoogle Scholar
  11. Fang, Hai, Yinzi Jin, Miaomiao Zhao, Huyang Zhang, John A. Rizzo, Donglan Zhang, and Zhiyuan Hou. 2017. Does migration limit the effect of health insurance on hypertension management in China. International Journal of Environmental Research and Public Health 14(10): 1256–1276.CrossRefGoogle Scholar
  12. Finkelstein, Amy, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, and Katherine Baicker. 2012. The oregon health insurance experiment: evidence from the first year. The Quarterly Journal of Economics 127(3): 1057–1106.CrossRefGoogle Scholar
  13. Glazerman, Steven, Dan M. Levy, and David Myers. 2003. Nonexperimental versus experimental estimates of earnings impacts. The Annals of the American Academy of Political and Social Science 589: 63–93.CrossRefGoogle Scholar
  14. Goldman, Noreen, Anne R. Pebley, Mathew J. Creighton, Graciela M. Teruel, Luis N. Rubalcava, and Chang Chung. 2014. The consequences of migration to the United States for short-term changes in the health of Mexican immigrants. Demography 51(4): 1159–1173.CrossRefGoogle Scholar
  15. Gong, Peng, Song Liang, Elizabeth J. Carlton, Qingwu Jian, Wu Jianyong, Lei Wang, and Justin V. Remais. 2012. Urbanisation and health in China. The Lancet 379(9818): 843–852.CrossRefGoogle Scholar
  16. He, Jiang, Gu Dongfeng, Jing Chen, Wu Xigui, Tanika N. Kelly, Jian-feng Huang, Jichun Chen, Chung Chen, Lydia A. Bazzano, Kristi Reynolds, Paul K. Whelton, and Michael J. Klag. 2009. Premature deaths attributable to blood pressure in China: a prospective cohort study. The Lancet 374(9703): 1765–1772.CrossRefGoogle Scholar
  17. Heckman, J.James, Hidehiko Ichimura, and Petra E. Todd. 1998. Matching as an econometric evaluation estimator: Evidence from evaluation a job training program. Review of Economic Studies 64: 605–654.CrossRefGoogle Scholar
  18. Hesketh, Therese, Ye Xue Jun, Lu Li, and Wang Hong Mei. 2008. Health status and access to healthcare of migrant workers in China. Public Health Reports 123: 189–197.CrossRefGoogle Scholar
  19. Hong, Yan, Xiaoming Li, Bonita Stanton, Danhua Lin, Xiaoyi Fang, Mao Rong, and Jing Wang. 2006. Too costly to be ill: healthcare access and health seeking behaviours among rural-to-urban migrants in China. World Health & Population 8(2): 22.CrossRefGoogle Scholar
  20. Hu, Xiaojiang, Sarah Cook, and Miguel A. Salazar. 2008. Internal migration and health in China. The Lancet 372(9651): 1717–1719.CrossRefGoogle Scholar
  21. Huang, Yeqing, Fei Guo, and Yiming Tang. 2010. Hukou status and social exclusion of rural-urban migrants in transitional China. Journal of Asian Public Policy 3(2): 172–185.CrossRefGoogle Scholar
  22. Huang, Yeqing. 2014. The continuity and changes of the hukou system since the 1990s: A critical review. In Urban China in the new era: Market reforms, ed. Z. Cheng et al., 25–43. Berlin: Springer.CrossRefGoogle Scholar
  23. Iacus, Stefano M., Gary King, and Giuseppe Porro. 2011. Multivariate matching methods that are monotonic imbalance bounding. Journal of the American Statistical Association. 106: 345–361.CrossRefGoogle Scholar
  24. Iacus, Stefano M., Gary King, and Giuseppe Porro. 2014. Causal inference without balance checking: Coarsened exact matching. Political Analysis 20(1): 1–24.CrossRefGoogle Scholar
  25. Imbens, Guido W. 2004. Nonparametric estimation of average treatment effects under exogeneity: A review. The Review of Economics and Statistics 86(1): 4–29.CrossRefGoogle Scholar
  26. Kim, Myoung H., Chang-yup Kim, Jin-Kyung Park, and Ichiro Kawachi. 2008. Is precarious employment damaging to self-rated health? Results of propensity score matching methods, using longitudinal data in South Korea. Social Science and Medicine 67(12): 1982–1994.CrossRefGoogle Scholar
  27. Keele, Luke. 2010. An overview of rbounds: An R package for Rosembaum bounds sensitivity analysis with matched data. White Paper, Ohio State University, Columbus, Ohio.Google Scholar
  28. King, Gary, and Richard A. Nielsen. 2018. Why propensity scores should not be used for matching. Political Analysis 27(4): 435–454.CrossRefGoogle Scholar
  29. Kleinbaum, David G., and Mitchel Klein. 2010. Logistic regression: A self-learning text, 3rd ed. New York: Springer.CrossRefGoogle Scholar
  30. Kuka, Elira. 2018. Quantifying the benefits of social insurance: Unemployment insurance and health (No. w24766). National Bureau of Economic Research. Review of Economics and Statistics(Forthcoming).Google Scholar
  31. Lei, Xiaoyan, and Wanchuan Lin. 2009. The new cooperative medical scheme in rural China: Does More coverage mean more service and better health? Health Economics 18(S2): S25–S46.CrossRefGoogle Scholar
  32. Liu, Tingting, Hong Feng, and E. Elizabeth Brandon. 2018. Would you like to leave Beijing, Shanghai, or Shenzhen? An empirical analysis of migration effect in China. PLOS ONE 13(8): e0202030.CrossRefGoogle Scholar
  33. Martinez, Omar, Wu Elwin, Theo Sandfort, Brian Dodge, Alex Carballo-Dieguez, Rogeiro Pinto, Scott Rhodes, Eva Moya, and Silvia Chavez-Baray. 2015. Evaluating the impact of immigration policies on health status among undocumented immigrants: A systematic review. Journal of Immigrant and Minority Health 17(3): 947–970.CrossRefGoogle Scholar
  34. McKenzie, David, and Marcin J. Sasin. 2007. Migration, remittances, poverty and human capital: Conceptual and empirical challenges. World Bank Policy Research Paper, 4272.Google Scholar
  35. Melander, Annika, and Kristyna Pelikanova. 2013. Reform of the hukou system: A litmus test of the new leadership. ECFIN, Economic Brief. European Commission. Issue 26.Google Scholar
  36. Mendez, Michael A., Richard Cooper, Rainford Wilks, Amy Luke, and Terrence Forrester. 2003. Income, education, and blood pressure in adults in Jamaica: A middle-income developing country. International Journal of Epidemiology 32: 400–408.CrossRefGoogle Scholar
  37. Meng, Xin. 2012. Labor market outcomes and reforms in China. The Journal of Economic Perspectives 26(4): 75–101.CrossRefGoogle Scholar
  38. Mou, Jin, Sian M. Griffiths, Hildy F. Fong, and Martin G. Dawes. 2015. Defining migration and its health impact in China. Public Health 129(10): 1326–1334.CrossRefGoogle Scholar
  39. Müller, Armin. 2016. The margins and the marginalised: Social policy, labour migration, and ethnic identity in contemporary China. Journal of Current Chinese Affairs 45(2): 53–82.CrossRefGoogle Scholar
  40. Nauman, Elizabeth, Mark VanLandingham, Philip Anglewicz, Umaporn Patthavanit, and Sureeporn Punpuing. 2015. Rural-to-urban migration and changes in health among young adults in Thailand. Demography 52(1): 233–257.CrossRefGoogle Scholar
  41. Nguyen, L.T., and M.J. White. 2007. Health status of temporary migrants in urban areas in Vietnam. International Migration 45: 101–134.CrossRefGoogle Scholar
  42. Pan, Jay, Xiaoyan Lei, and Gordon G. Liu. 2016. Health insurance and health status: Exploring the causal effect from a policy intervention. Health Economics 25: 1389–1402.CrossRefGoogle Scholar
  43. Peng, Yingchun, Wenhu Chang, Haiqing Zhou, Hu Hongpu, and Wannian Liang. 2010. Factors associated with health-seeking behaviour among migrant workers in Beijing, China. BMC Health Services Research 10(1): 1–10.CrossRefGoogle Scholar
  44. Rosenbaum, Paul R., and Donald B. Rubin. 1983. The central role of the propensity score in observational studies for causal effects. Biometrika 70(1): 41–55.CrossRefGoogle Scholar
  45. Rosembaum, Paul R. 2002. Observational studies, 2nd ed. New York, NY: Springer.CrossRefGoogle Scholar
  46. Rosembaum, Paul R. 2005. Observational study. In Encyclopedia of statistics and behavioral science, vol. 3, ed. B. Everitt and D. Howell. Hoboken: Willey.Google Scholar
  47. Rubin, Donald B., and Nigel P. Thomas. 1996. Matching using estimated propensity scores: Relating theory to practice. Biometrics 51: 249–264.CrossRefGoogle Scholar
  48. Stuart, Elizabeth A. 2010. Matching methods for causal inference: A review and a look forward. Statistical Science 25: 1–21.CrossRefGoogle Scholar
  49. Song, Qian. 2016. More than a place of residence: Hukou system, migration, and the rural-urban health divide among middle-aged and older Chinese. Mimeo: RAND Corporation.Google Scholar
  50. Song, Yang, and Wenkai Sun. 2016. Health consequences of rural-to-urban migration: Evidence for panel data in China. Health Economics 25: 1252–1267.CrossRefGoogle Scholar
  51. Sun, Zhaoqing, Liqiang Zheng, Xu Changlu, Jue Li, Xingang Zhang, Shuangshuang Liu, Jiajin Li, Hu Dayi, and Yingxian Sun. 2008. Prevalence of prehypertension, hypertension and associated risk factors in Mongolian and Han Chinese populations in northeast China. International Journal of Cardiology 128(2): 250–254.CrossRefGoogle Scholar
  52. Sun, Meiping. 2017. The potential causal effect of hukou on health among rural-to-urban migrants in China. Columbia University Working Paper and Job Market Paper.Google Scholar
  53. Tani, Massimiliano. 2017. Hukou changes and subjective well-being in China. Social Indicators Research 132: 47–61.CrossRefGoogle Scholar
  54. Timpka, Simon, Ingemar F. Petersson, Caddie Zhou, and Martin Englund. 2014. Muscle strength in adolescent men and risk of cardiovascular disease events and mortality in middle age: A prospective cohort study. BMC Medicine 12(1): 1–10.CrossRefGoogle Scholar
  55. Wang, Fei-Ling. 2010. Renovating the great floodgate: The reform of China’s hukou system. In One country, two societies: Rural-urban inequality in contemporary China, ed. M.K. Whyte, 335–365. Cambridge: Harvard University Press.CrossRefGoogle Scholar
  56. Wang, Hui, Pengyu Zhu, Xiao Chen, and Sarah Swider. 2017. Land expropriation in urbanizing China: An examination of negotiations and compensation. Urban Geography 38(3): 401–419.CrossRefGoogle Scholar
  57. Wassink, Joshua T., and Jaquline M. Hagan. 2018. A dynamic model of self-employment and socioeconomic mobility among return migrants: The case of urban Mexico. Social Forces 96(3): 1069–1096.CrossRefGoogle Scholar
  58. Wei, Xiaolin, Stephen Pearson, Zhanxin Zhang, Jiangmei Qin, Nancy Gerein, and John Walley. 2010. Comparing knowledge and use of health services of migrants from rural and urban areas in Kunming city, China. Journal of Biosocial Science 42(06): 743–756.CrossRefGoogle Scholar
  59. Williams, Richard. 2006. Generalized ordered logit/partial proportional odds models for ordinal dependent variables. Stata Journal 6: 58–82.CrossRefGoogle Scholar
  60. Zhang, Zu. 2014. The health status of migrant workers in China. Harvard International Review.
  61. Zhang, Jipeng, Ru Wang, and Lu Chong. 2018. A quantitative analysis of hukou reform in Chinese cities: 2000-2016. Growth and Change 50: 201–221.CrossRefGoogle Scholar
  62. Zhu, Shankuan, Xiaoguang Ma, and Jin-Ling Tang. 2011. What is the optimal body mass index for Chinese people? CMAJ 183(6): 645–664.CrossRefGoogle Scholar

Copyright information

© EEA 2019

Authors and Affiliations

  1. 1.Department of Economics and Business, Colin Powell SchoolCity University of New YorkNew YorkUSA
  2. 2.South African Research Chair in Industrial Development, University of JohannesburgJohannesburgSouth Africa
  3. 3.Social Sciences Data LabCIRANOMontrealCanada
  4. 4.Department of Public Administration and International Affairs, Maxwell School of Citizenship and Public AffairsSyracuse UniversitySyracuseUSA

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