Research Project on
Migration and Health in China: An Institutional Analysis
Researcher: Xiang Biao
Asian MetaCentre for Population and Sustainable Development Analysis and
Asia Research Institute
There are currently at least 85 million rural-urban migrants in mainland China. These migrants face high health risks, yet are not covered by any medical care scheme. This project attempts to map out the migrants’ basic health problems, identify the policy gaps in providing basic health services to them, and explore possible solutions to this issue.
This study consists of three stages: (1) documentary research (December 2002 - May 2003), (2) fieldwork investigation in Beijing and Zhejiang, China (April - May 2003), and (3) data analysis and writing up (May – June 2003).
The study reveals that the key issue for migrants’ health is not their social characteristics such as low income or the lack of health awareness, as most literature has emphasised, but is a matter of institutional arrangement with respect to health security and service provision. Unlike in other countries, the rural-urban dualism and the unique household registration system in China render internal migrants an institutionally marginalised group that cannot access services in either cities or villages.
The series of institutional arrangements not only render migrants vulnerable, but also impede them from being included in the formal medical care system. The reasons include: the vested interests and the government’s immediate goal in reforming social security system lend the State no motivation to extend medical care scheme to cover migrants; the gap between the urban and the rural in medical care makes it hardly operational to include a group characterised by constant rural-urban mobility in the system; the localised therefore geographically fragmented operation pattern also discourage migrants to join; finally, the informal employment relationship prevalent among migrant workers conflicts with the fact that the medical care system relies on formal employment contracts for its implementation.
Alternatively, the investigation finds that grassroots activities can be an important means of providing basic health services for migrants for the time being. Activities proven to be effective in practice include providing health education, expanding urban community health services to cover migrants, allowing for or even encouraging primary clinics set up by migrants themselves, and empowering migrants by providing legal assistance and developing migrants’ own organisations. Though these activities cannot directly change the formal policies, they will have institutional implications in the long run.
Xiang Biao (forthcoming in 2003) Migration and Health in China: An Institutional Analysis, Asian MetaCentre Research Paper Series.