Climate change have made some serious impact for the human health around the world. For avoiding or lowing this threaten, many people have to move to a suitable region in different season. Comparing with the local residents, most immigrants were the elder, they have to spend more time to adapt the new environment. In the field of health service, they could not get the regular physical examination like the local residents. Especially in China, the distribution of medical resources is unbalanced and there are lots floating population who set in a weak position and cannot receive a timely treatment once they got illness. In China, in the winter, the northern region have a lowest temperature than other regions and with the climate change, the cold spell days is becoming more frequent and longer. Lots elderly residents have to move to a warm area to avoid the impact of cold weather and Hainan province as the southernmost region with a suitable climate in the winter attracts lots elderly people to visit and live there until Spring comes next year. In this study we survey the level of utilization of physical examination for those seasonal immigrants and analyze the factors of influencing the physical examination.
In this study we found only 26.80% seasonal immigrants received PE. This prevalence is much lower than previous studies by Ge DD et al. (76.20%)21 and Sun X et al. (63.50%)20. Some reasons may explain this result. First, almost seasonal immigrants came to Sanya during the winter, and most temporarily lived nearly half of a year in Sanya without the normal health services like the local residents. Then lot of them came to Sanya just to relax themselves and didn’t pay much attention to the regular physical examinations.
In this study we don’t find the difference in the use of PE between rural and urban. This is different from the previous studies, which reported the utilization rate of PE among urban residents was higher than residents in rural residents.21,22 That maybe due to there are huge differences in health resources between city and country, but those seasonal immigrants use the same health resources in Sanya which reduced the impact from differences of medical resource between city and country23. We had not found evidence for the impact of genders, age, marital status, economic status, working status on the utilization of physical examination and this is not consistent with previous studies.24-27 Gong CH et al. found PE increased significantly by age and those who had higher household expenditure were also more likely to have PE.28 However, we can’t get the same result, that could be explained that since in 2003 China introduced New Cooperative Medical Scheme, which enhanced the financing standard and reduced the burden for the low income families.29 Most seasonal immigrants came to Sanya with their spouse and they have the same lifestyle, so between the different gender, there may be not much difference in the utilization of PE. With the growth of age, we find the utilization rate of PE also improved (50–59, 21.80%; 60–69, 26.70%,70–79, 29.50%; 80+, 42.40%), but the logistic regression model display age wasn’t the influencing factor. But in the model we find the AOR of age over 80 is 1.81 and the AOR95%CL was 0.80–4.07 which was a wide confidence interval. In addition to this, we find the percent of age over 80 was only 2.50%, which may effect on the final analysis. So a further research is needed to understand whether the age effect the use of PE.
Consisting with one previous study30, we found seasonal immigrants with lower education compared with those college or advanced degrees, would be more like to use PE. But there also have some studies got the contrary conclusion. Some studies found people with higher education will be more positive to have PE and high education mean high economic status and more active to search for PE28,21. People with high education also mean they may have a high awareness of self-care, they could use more way to find self-health status like smart phone, family doctor which could decrease the frequency of going to the hospital for PE.32
In this study we find the time with living in Sanya is one influencing factor for the use of PE, which could be explained that when immigrants come into a new place with the living-time going, they maybe exposure more harmful factors. Especially Hainan belongs to the largest tropical monsoon region33 and with a higher temperature than other districts in China. The longer immigrants live in there, the more possible people exposure to high temperatures. And lots of studies have shown high temperature will bring many negative impacts on people especially for those who with disease like respiratory disease, cardiovascular disease34,35.
Unexpected, not like other study21,36,37 ,we found these without health insurance rather than those with health insurance (UEBMI: AOR = 0.59, p = 0.015; URBMI:AOR = 0.49, p = 0.012), were more like to have PE. That may be related with the availability of local health service. We found although about 80.60% seasonal immigrants have the health insurance or enjoy public medical care, actually those whose health insurance could be used in Sanya was only about 24.90%. So, most immigrants can’t timely get the health services. People with health insurance could be used in Sanya would be more like to have PE (AOR = 2.19,p < 0.001), which further explained the importance of the availability of health insurance in Sanya. Through surveying the attitude to the quality of health service in Sanya, we could analyze subjective influences to get PE. The higher the degree of evaluation, the more likely to participate in the PE (Same as origin: AOR = 1.51, p = 0.005; Better than origin: AOR = 1.74, p = 0.002) which consist with another research38. When people believe the level of health services, they may be willing to accept the relevant treatment with a positive attitude.
Seasonal immigrants is becoming more common due to climate change around the world and improve the level of health services for the immigrants in the immigrant land is very important to keep their heath. And through this study in China we found the level of physical examination is low for the seasonal immigrants which give an information that government need to pay more attention to the immigrants and take effective measures to meet health demand of immigrants.