Health service delivery and subsequent labor out-migration in Vietnam: a longitudinal multilevel study

Local health services may influence labor mobility through competing pathways. Reliable clinical services may encourage residents to remain, whereas formal-care capacity may reduce household caregiving constraints and facilitate migration. Evidence is limited in developing countries. We examined whether health-service conditions in the province of origin were associated with subsequent work-related out-migration in Vietnam. We linked four biennial Vietnam Household Living Standards Survey transitions from 2010 to 2018 with province-level health and socioeconomic indicators across all 63 provinces. The dataset included 42,150 person-transition observations among individuals aged 15–60 years; 41,344 complete observations were used in the main analysis. Work-related migration was identified when a baseline household member left for employment during the following two years. Multilevel mixed-effects logistic models included household and province random intercepts, individual and household covariates, provincial controls, and year fixed effects. Interaction and sensitivity analyses assessed heterogeneity and robustness. Greater medical-staff density was associated with lower migration odds (AOR 0.883, 95% CI 0.813–0.960); a one-SD increase corresponded to a − 0.564-percentage-point difference in adjusted migration probability (95% CI − 0.817 to − 0.312). District-bed density (AOR 1.087, 95% CI 1.023–1.154) and commune-bed density (AOR 1.063, 95% CI 1.007–1.121) were positively associated with migration in the main model, but were less stable across sensitivity analyses. Health-insurance ownership was associated with lower migration odds (AOR 0.722, 95% CI 0.594–0.879). The pharmaceutical-staff association increased across household income and remained significant after Benjamini–Hochberg adjustment (interaction p = 0.007; q = 0.043). Across alternative specifications, the negative medical-staff association was the most consistent finding, although not invariant; alternative service-use and diagnostic-capacity indicators were not significant. Health-service delivery is a multidimensional component of the local environment associated with labor migration. Greater medical-staff availability showed a relatively robust association with local retention, whereas evidence for caregiving release through bed capacity was weaker and specification-dependent. The insurance finding may reflect both mobility frictions and formal employment or job stability. These observational findings are conditional associations, not causal effects. Strengthening local clinical capacity, continuity of primary care, community and long-term-care support, and portability of health-insurance benefits may improve health-system performance and support workers’ mobility decisions.