title: UTILIZATION OF HEALTH CARE SERVICES AMONG INTERNAL MIGRANTS IN HANOI AND ITS CORRELATION WITH HEALTH INSURANCE: A CROSS-SECTIONAL STUDY.
abstract: BACKGROUND
  Economic transition (DoiMoi) in the 1980s in Viet Nam has led to internal migration, particularly rural-to-urban migration. Many studies suggested that there is a difference between non-migrants and migrants in using health care services. Current studies have mostly focused on migrants working in industrial zones (IZs) but migrants working in private small enterprises (PSEs) and seasonal migrants seem to be ignored. However, these two groups of migrants are more vulnerable in health care access than others because they usually work without labor contracts and have no health insurance. The study aims to compare the utilization of health care services and explore its correlated factors among these three groups.
  
  
  METHODS
  This cross-sectional study included 1800 non-migrants and migrants aged 18-55 who were selected through stratified sampling in Long Bien and Ba Dinh districts, Hanoi. These study sites consist of large industrial zones and many slums where most seasonal migrants live in. A structured questionnaire was used to collect information on health service utilization in the last 6 months before the study. Utilization of heath care services was identified as "an ill person who goes to health care centers to seek any treatment (i.e. both private and public health care centers)".
  
  
  RESULTS
  644 of 1800 participants reported having a health problem in the last 6 months before the study. Among these 644 people, 335 people used health care services. The percentage of non-migrants using health care service was the highest (67.6%), followed by migrants working in IZ (53.7%), migrants working in PSE (44%), and seasonal migrants (42%). Multivariate logistic regression showed migrants, especially seasonal migrants and migrants working in PSE, were less likely to use health care services (OR=0.35, p=0.016 and 0.38, p= 0.004, respectively), compared to non-migrants. The study also found that having no health insurance was a risk factor of the utilization (OR=0.29, p<0.001). Other factors such as gender, age, marital status, socioeconomic status, and monthly income were not related to the utilization of health care services.
  
  
  CONCLUSIONS
  Seasonal migrants have the worst utilization of health care services, followed by migrants working in PSE, migrants working in IZ, and non-migrants. Health insurance is an important factor relating to the utilization. Accordingly, health insurance coverage needs to be increased if utilization of health care services for the whole population, particularly migrant population, is to be improved.
authors.affiliation: Department of Epidemiology and Biostatistics, Hanoi School of Public Health, Viet Nam.
authors.forename: Anh Thi Kim
authors.initials: AT
authors.lastname: Le
authors.affiliation: Department of Epidemiology and Biostatistics, Hanoi School of Public Health, Viet Nam.
authors.forename: Lan Hoang
authors.initials: LH
authors.lastname: Vu
authors.affiliation: Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.
authors.forename: Esther
authors.initials: E
authors.lastname: Schelling
keywords: Ha Noi; Viet Nam; correlates; health care services; health insurance; migrants; utilization