Migration and Health in China: An Institutional Analysis

here are currently at least 85 million rural-urban migrants in the mainland China. These migrants face great health risks, yet are not recognised or covered by any medical care scheme. This paper demonstrates that the key issue for migrants’ health is not their social characteristics such as low income or the lack of health awareness, as most literature has emphasised, but lies in the institutional arrangements regarding health security and service provision. Unlike in other countries, rural-urban dualism and a unique household registration system in China render migrants unable to access public services in either cities or villages. T I will first review the basic health problems facing migrants, and then explore the question of why migrants are not included in the new medical care system that supposedly aims to cover as many people as possible. I suggest that the reasons lie in various structural and institutional factors far more fundamental than medical care itself. They include the rural-urban divide in welfare provision; the potential conflicts between the government’s immediate goal in medical care reform (to relieve Stateowned enterprises from welfare burdens) and the costs of including migrants in the system; the tension between the informal employment relationship prevalent among migrants and the current medical care schemes’ reliance on formal employment relationship in implementation; and finally the friction between migrants’ mobility and the scheme’s localised operation pattern. Alternatively, I suggest that grassroots activities can become an important means of providing basic health services for migrants. Activities proven to be effective in practice include providing health education, extending urban community health services to migrants, allowing for or even encouraging the setting up of clinics by migrants themselves, and empowering migrants by providing legal assistance and developing migrants’ self-help organisations. Though these activities cannot change formal policies immediately, they may have far-reaching institutional implications in the long run.