Utilization of public health services and health outcomes among China's migrant population: an equity analysis.

Background: The equalization of basic public health services is a core component of China's healthcare reform, which is aimed at promoting the health of the general population. Improving migrants' access to these services and enhancing their health outcomes are important objectives of this policy. While previous studies have documented income-related inequalities in the utilization of public health services and health status among migrant populations, insufficient attention has been paid to the impact of public health service utilization on health outcomes and the realization of health equity. Purpose: This study examined the relationship between public health service utilization and health outcomes among China's migrant population. Specifically, it assessed equity in public health service utilization and health status, analyzed the effects of service utilization on health outcomes, and explored the implications of these services for health equity. Methods: Data were drawn from the 2018 China Migrants Dynamic Survey, yielding a final sample of 4,034 participants after data cleaning. The corrected concentration index was used to assess equity in the utilization of four public health services-health education, health record establishment, family doctor contracting, and inpatient care-as well as equity in health status. Ordered logistic regression models were applied to estimate the effects of public health service utilization on health outcomes. In addition, concentration index decomposition was conducted to evaluate the contribution of service utilization to health equity and to examine heterogeneity across subgroups. Results: Significant disparities were observed in public health service utilization among migrants. Health education had relatively high coverage, whereas health record establishment, family doctor contracting, and inpatient care were underutilized. Income-related inequalities were evident in service utilization: health education showed a pro-rich distribution, while health record establishment, family doctor contracting, and inpatient care showed pro-poor distributions. Although migrants generally reported good self-rated health, notable income-related health inequalities persisted. Overall, all four types of public health services were associated with better health status, with preventive services showing stronger effects than inpatient care. In terms of health equity, health education tended to widen health inequalities, whereas health record establishment and family doctor contracting helped reduce them. Heterogeneity analysis further indicated that these effects were more pronounced among socioeconomically disadvantaged migrant subgroups. Conclusion: Public health service utilization and its equity vary substantially across different service types among China's migrant population. Although these services generally contribute to improved health status, their impacts on health equity differ significantly. Policies should therefore focus on expanding access to essential public health services and tailoring service delivery to the specific needs of disadvantaged migrant groups, with the aim of enhancing both health outcomes and health equity.