Local Enrollment or Cross‐Regional Portability? Public Healthcare Service Utilization and Older Migrants' Settlement Intentions in China
2026-09-08
China has substantially reformed its medical insurance system to enable direct cross‐regional settlement of medical expenses since the late 2000s, yet little is known about how different forms of medical insurance participation—local enrollment vs. cross‐regional portability—differentially shape older migrants' settlement intentions. To address this gap, using nationally representative survey data on 5002 older migrants who have reached the statutory retirement age, this study examines how public healthcare service utilization influences older migrants' settlement intentions in China. Public healthcare service utilization is measured using four indicators: participation in destination‐based medical insurance, participation in origin‐based medical insurance with direct settlement at the destination, establishment of a local resident health record, and participation in health education activities. Multinomial probit models are used to account for the categorical nature of settlement intentions: no intention, short‐term intentions, and long‐term intentions. Model results show that older migrants enrolled in destination‐based medical insurance are more likely to express long‐term settlement intentions, whereas those relying on origin‐based insurance with cross‐regional settlement tend to exhibit short‐term intentions. In addition, older migrants who have established a local resident health record are more likely to express long‐term settlement intentions. Furthermore, origin–destination disparities in the quantity and quality of medical service provision significantly moderate the association between medical insurance participation and older migrants' settlement intentions. Our findings advance understanding of older migrants' settlement intentions by revealing the divergent effects of local enrollment and cross‐regional portability on long‐term vs. short‐term settlement, and by highlighting the moderating role of origin–destination disparities in medical service provision, with implications for deepening cross‐regional settlement reforms to better facilitate the long‐term urban integration of older migrants.