The impact of public health services on the quality of life of migrants in China: an examination based on health records and health education

BACKGROUND: Public health services accessible to urban migrants not only directly impact their health status, but may also significantly influence subjective well-being. However, existing research predominantly focuses on objective welfare aspects (e.g. disease prevention and health management), while largely neglecting its impact on subjective well-being domains such as quality of life (QoL). This study bridges this gap by extending the analytical scope of public health services (including health records and health education) from objective welfare to subjective well-being domains, thereby providing novel insights into the formation mechanisms of health equity pertaining to migrants' QoL. METHODS: Causal effect analysis was conducted using a cross-sectional dataset from the 2017 China Migrants Dynamic Survey (CMDS; valid sample size n = 154,586). Baseline estimates were generated using ordinary least squares (OLS) regression, while the conditional mixed-process (CMP) estimator and omitted variable tests were employed to correct for endogeneity issues related to health records and health education. Additionally, the Karlson-Holm-Breen (KHB) decomposition method was used to explore mediating mechanisms. RESULTS: Establishing health records (β = 0.0186, p < 0.01) and receiving health education (β = 0.0192, p < 0.01) significantly improved the QoL of migrant populations, and these findings held after correcting for endogeneity. Heterogeneity analysis revealed that these positive effects were more pronounced among older generations, females, urban-to-urban migrants, and inter-provincial migrants. Further KHB mediation analysis identified significant mediating roles for health habits, health behaviors, social interaction, and local identity, with local identity contributing the largest share of the mediating effect. CONCLUSION: Government provision of equalized public health services to migrants can significantly enhance their QoL. This process is primarily realized through mediating mechanisms such as improved health habits, shaped health behaviors, expanded social interaction, and strengthened local identity Therefore, we recommend incorporating public health services into the top-level design of migrant social integration policies as a crucial means to achieve universal health coverage and promote social equity.