Healthcare migrants under the uneven distribution of health resources and their impacts on neighborhoods in urban China

Abstract

Health equity in China has long been the focus of academic circles, but few research addresses on the geographical distribution of high-quality healthcare resources. Moreover, the “difficulties in accessing medical services” and the “emergence of trans-regional/provincial/city patients” are closely related to the failure of central planning on high-quality healthcare resources. Inspired by health geography, health tourism and patient mobilities, this thesis focused on evaluating the spatial distribution of high-quality healthcare resources, exploring the medical travel and health utilization of healthcare migrants, and examining subsequent neighborhood-level socio-spatial restructuring. This thesis adopted mixed research methods for the data collection and analysis to examine these multi-dimensional socio-spatial issues. Firstly, based on the self-built database of high-quality healthcare resources in China and generalized entropy, this thesis indicated that spatial disparities of high-quality healthcare resources were apparent at city, provincial and regional levels. The spatial disparities had deep institutional and political roots, including lacking central coordination on planning high-quality healthcare resources, tiao-kuai segmentation, fiscal decentralization reform on the provision of public services, regional disparities in economic development and medical-related technologies. Besides, the results conveyed that the newly introduced policies on balancing high-quality healthcare resources or assisting healthcare migrants were still on the way to be effective. Secondly, the questionnaire data and interviews, this thesis has drawn the following conclusions on healthcare migrants: The spatial patterns of the patient mobilities were consistent with the geographical distribution of high-quality medical resource; The mobility patterns of healthcare migrants were simultaneously constrained by individuals’ socio-economic status and the availability of high-quality healthcare resources; The health promotion for healthcare migrants via mobilities was generally optimistic, while the effectiveness of diagnosis and treatment also differed among different medical travel patterns. Thirdly, this thesis explored the socio-spatial impacts (physical, economic and social ones) of patient mobilities on the neighborhoods adjacent to first-tier hospitals in Guangzhou and Wuhan. The author summarized certain conditions precede the formation of patient-neighborhood. Based on observation, the neighborhoods where the healthcare migrants were living in had experienced significant physical restructuring. The physical restructuring was comprised by market-driven and government’s proactive intervention. In addition, many patient-related economies were identified, including (in)formal housing rental markets, rehabilitation institutions, patient-caring services, pharmacies, the funeral industry and patient-targeted long-distance transportation services. This thesis paid more attention to the underground informal housing markets by focusing their modes of operation, marketing strategies and competitions. Also, several patient-neighborhoods were identified in Guangzhou and Wuhan, three on them were experiencing residential segregation. The results revealed that there were social interactions within patient’s neighborhoods, and these acted as a form of collective empowerment. Although patient-neighborhoods were featured by informal, crowdedness, unsanitary and poor services, considering health promotion and reducing economic pressure, many healthcare migrants chose to live in patient-neighborhoods as a makeshift strategy. Also, this thesis contributed to the existing literature in the following aspects. The author argued that conventional studies of health tourism had paid insufficient attention to domestic patient mobilities/medical travels, a new conceptual framework to define health and medical tourism by incorporating both international and domestic patient mobilities should be made. By addressing this, this thesis contributed to enrich the categories of medical tourism and discover more mechanisms of medical travels. Also, the author’s analysis proved that health behavior was able to produce socio-spatial restructuring at the neighborhood-level. The dynamic in this thesis was different from that of traditional therapeutic landscapes (centering on the health-related setting), which might enhance our understanding on the relation of space and health or even potentially extend the scope of health geography and health tourism. Based on domestic patient mobilities in China, this thesis made a new attempt to bridge patient mobilities, medical/health tourism and geographies of health. Lastly, the findings of this thesis yielded a series of policy implications, including setting up a committee for accessing and coordinating the allocation of high-quality healthcare resources in China, accelerating the establishment of national and regional medical centers, strengthening publicity and implementation of THCDS and DT, setting up special funds for poor healthcare migrants and striking a balance between regulation and humanistic care.