Effect of rural-to-urban migration on the healthcare utilisation of middle-aged and elderly adults: evidence from the China Health and Retirement Longitudinal Study

Abstract Background: An increasing number of middle-aged and elderly adults are migrating from rural to urban areas for employment, to care for their younger generation and due to old age. As these age groups move into urban areas, their healthcare service utilisation are directly related to their health status and basic rights to survival. It also places higher demands on China’s healthcare service provision. This study aims to investigate the effect of middle-aged and elderly adults migrating from rural to urban areas on their healthcare service utilisation. Methods: Panel data from Wave 3 (2015), Wave 4 (2018) and Wave 5 (2020) of the nationally representative China Health and Retirement Longitudinal Study were selected to obtain a sample of 456 participants in the treatment group and 9171 participants in the control group. The difference-in-differences propensity score matching estimator method was used to explore the effect of migrating to a city on the utilisation of healthcare services amongst middle-aged and elderly adults. Results: Calliper nearest-neighbour matching significantly improved overall balance after matching. The DID regression results showed that middle-aged and elderly adults significantly reduced their number of hospitalisations when they moved to a city, with a DID value of −0.093 (p0.05). The DID results were consistent with the robustness test. Further examination of heterogeneity determined that it had a more significant negative effect on the number of hospitalisationsamongst individuals aged 45–59 years, of rural hukou status and with poor self-assessed health status. Conclusion: Middle-aged and elderly migrants moving to cities may reduce their healthcare utilisation. The government should improve its outpatient reimbursement policy and the policy of medical treatment in other places; encourage the society, community and family to give more attention to middle-aged and elderly adults migrating to cities; improve their health literacy and help them set up the correct concept of medical service utilisation to promote the health equity of migrant populations.