Publication Details

Internal migration and 'rural/urban' households in China

implications for health care

Chen Chuanbo
Henry Lucas
Gerald Bloom
Ding Shijun
2010

Abstract

Limitations on family size and increases in life expectancy have resulted in a steady ageing of the rural Chinese population (Hesketh et al, 2005). This has been exacerbated by the outmigration in search of employment of predominantly younger adults. Around 140 million Chinese, some 10% of the population, are classified as members of the “floating” population, the great majority of these being rural-urban migrants (Song and Appleton, 2008). A substantial proportion of rural households, especially in poor areas, now have one or more registered members living for much of the year in an urban area.

While these migrants often only return home for the spring festival, they typically remain intimately linked to their rural household which may include their spouse, parents and children. Their remittances may often be the main source of household income and they provide a potentially very important financial safety net against the risk of crop failure, ill-health or other shock to rural household livelihoods. When they do return home they will often bring a variety of household goods, food stocks and medicines. The importance of their contribution will typically allow them to play a full role in household economic decision making.

However, their physical absence may greatly increase the burdens assumed by those who remain behind in terms of both productive and reproductive serious for the elderly in households where all the younger adults migrate, possibly leaving young children in their care. Such burdens tend to increase both the susceptibility to ill-health and its impact on household livelihoods. The rural elderly may have to continue to work in spite of relatively serious health problems, simply because there is no one in the household who can take their place. They similarly have no one to provide home-based care or assist them in accessing formal health services when they experience ill-health. Chronic illness of those in the older age groups has become the leading cause of death and disability in rural China (Shi et al, 2008. Wang et al, 2007).

The migrants may also have difficulty in obtaining care because their registration status means that they have no right of access to most urban health services. Those who are seriously ill and thus unable to work may have no choice but to return home. This leads to the phenomenon sometimes described in China as ‘rural areas export good health and re-import ill-health’. Given the decentralization of responsibility for health financing, the cost of caring for these returnees will be borne either by their family and friends or by the rural county government. Recent reforms have seen the introduction of the New Community Medical System (NCMS) a rural health insurance scheme that is heavily subsidised by central government in poor rural areas. However, relatively low reimbursement rates, and an exclusive focus on impatient care, have limited the assistance that it can provide to the households described above (Yip and Hsiao, 2009).

Publication Type(s)

Conference Paper

Ten Years of War Against Poverty Conference Papers

Conference: Ten Years of War Against Poverty

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