China’s health challenges are similar to many other transitioning countries, where rural–urban migrants are at higher risk for many health problems than their local counterparts . According to the World Health Organization (WHO), the right to the highest attainable health is a fundamental human right . High quality primary health care is essential in protecting and maintaining the population’s health. China is implementing a primary health care led system through Community Health Centers (CHCs) as a strategy to create a more equitable and efficient health system. Therefore, to achieve the overall goal of better health for all, China needs to provide quality primary health care to all inhabitants including migrants. However, information on the differences in quality of primary health care delivered by CHCs to migrants and local residents, information essential for better future health care planning, is lacking.
China has a large number of internal migrants (nearly 230 million by the end of 2011) . They are normally from rural areas and seeking better paid jobs in cities . The term internal migrants in China usually refers to those who do not change their official hukou registration to the new location which they move to (i.e., floating or non-permanent residents) . Hukou refers to a household registration status officially issued, often on a family basis, to identify a person’s official place of residence. Hukou defines a person’s access to employment, housing, social welfare, educational opportunities and medical and other services. Shenzhen is one of the most populous metropolitan areas located in the Pearl River Delta in Southern China, attracting millions of rural laborers to work as non-permanent migrants . By the end of 2012, the number of internal migrants in Shenzhen reached nearly 12.6 million, which was about 80% of the total population of Shenzhen . To facilitate migrant population management and reduce gaps between migrants and local hukou holders in accessing social welfare, including government-sponsored housing, education, employment and medical insurance, Shenzhen initiated its resident card system in August 2008 to replace the former, discriminatory, temporary residence regime. This new system is open to all non-hukou non-student migrants above 16 years old and has covered more than 10 million people since 2009. Registration into the system is convenient and free. A Shenzhen resident card ensures, under certain additional conditions, legitimacy for migrants to join the city’s Comprehensive Health Insurance Scheme (CHIS) as an individual (instead of as an employee within a working unit). However, due to the higher premium fee, migrants tend not to join CHIS. Whilst all employed migrants are entitled to join the Medical Insurance System for Migrant Employees (MISM), which strictly defines workers’ first contact to be with the city’s 611 primary care providers, i.e., Community Health Centers (CHCs). A referral system from CHCs exists to make sure that care in the community leads the following triage into any necessary secondary or tertiary care. Whilst CHIS participants can choose between hospital outpatient services and CHC clinics as the first contact, they generally pay higher premiums than MISM insurees.
Migrants are generally less skilled and minimally educated, and hence tend to have lower incomes than their local counterparts, leading to poorer access to health care . Their lack of health insurance makes the situation even worse, resulting in unsatisfactory health outcomes . Research suggests that migrants are more likely than local residents to seek health care from CHCs, the major primary health care providers in China, due to the lower costs as compared to the costs of using secondary and tertiary care facilities . Given the important role played by primary health care in protecting migrants’ health, the quality of primary health care is of great concern for quality improvement for services and health improvement among migrants.
Patient satisfaction is one of the most widely used outcome indicators to measure quality of care from patients’ perspective . The assessment of patients’ perception can be seen as a direct measure of quality of care received . Literature indicates that quality of care, specifically patient satisfaction, is an important area because it helps physicians and health care organizations better understand patients’ points of view, and use this feedback to increase accountability and improve the services provided [12, 13]. In this paper, we compare patient satisfaction with primary health care provided by the CHCs in Shenzhen between non-permanent migrants and local hukou residents, as well as assessing their willingness to use and recommend primary health care to others.