BackgroundWith a large population of internal migrants from all over the world, China has the largest number of internal floating migrants, and most of them (up to 169 million in 2016) are rural-to-urban migrants. Those migrants have difficulty accessing essential health care services because of Hukou, leading to disparities in health needs and utilization between rural-to-urban migrants and residents. To compare the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016.MethodWe used longitudinal data from the Chinese Labor Dynamic Survey (CLDS) with three waves in 2012, 2014 and 2016. Descriptive analysis was employed to show self-reported illnesses and health services utilization among locals and migrants in the most recent 2 weeks in China. Chi-square tests and log binomial regression models were constructed to explore factors influencing health care needs and utilization.ResultA total of 19.97% of respondents were rural-to-urban migrants, with an upward trend from 2012 to 2016. Rural-to-urban migrants (11.99%) had higher needs for health services than urban residents (10.47%) in general, while urban residents and migrants had no differences in needs in 2012. Besides, there was no difference in the utilization of health services between residents and migrants in 2012, 2014 or 2016. In addition, increased age, male sex, poor medical insurance coverage and dissatisfaction with income were found to have negative effects on health care needs.ConclusionThis study has shown that the rural-to-urban migrants had higher health care needs but the same health care utilization compared with urban residents in China. Health policies focusing on equitable health outcomes should pay more attention to rural-to-urban migrants in China’s health care system reform.

INTRODUCTION:To determine whether outpatient induction of labor (OP-IOL) using balloon catheters improved outcomes and resource utilization when compared with inpatient (IP)-IOL.METHODS:Outcomes in low-risk singleton pregnancies from April 2016 to December 2018 after introduction of an OP-IOL protocol were compared with those that underwent IP-IOL between April and December 2016 at the same institution.RESULTS:We included 225 IP- and 850 OP-IOL cases. Prostaglandin was more commonly employed in operator-determined IP-IOL (78.7%), while balloon catheters were almost exclusively used in OP-IOL (95.4%), consequent to a unit policy. There was no difference in caesarean deliveries (CDs) (adjusted odds ratio [aOR], 1.25 [95% CI, 0.76, 2.08]), neonatal intensive care unit admission, 5-minute Apgar scores less than 7, or maternal adverse events after onset of labor. Those undergoing OP-IOL were less likely to need a second induction agent (aOR 0.19 [95% CI 0.11, 0.33]) but experienced more maternal adverse events related to the induction (aOR 3.72 [95% CI 1.24, 11.75]), a longer median IOL-to-delivery interval (19.13 versus 30.14 hours [7.28, 11.80]), although a median of 13.83 of these 30.14 hours were spent outside the hospital. There were no differences in the admission-to-delivery (−1.45 hours [–3.29, 0.38]) and total hospitalization time (0.66 hours [–3.93, 5.25]).CONCLUSION:Although IP- and OP-IOL had comparable CD and neonatal outcomes, operator-determined IP-IOL had significantly shorter IOL-to-delivery. A universal policy of OP balloon catheters did not shorten duration of hospitalization, but increased IOL-to-delivery and maternal adverse events. Whether an individualized approach to OP-IOL could reduce resource utilization needs to be explored.