International population mobility is a significant challenge for the management of the coronavirus (COVID-19) pandemic, an ongoing public health crisis spreading around the world. The suspension of flights and other traffic has been adopted as an important measure to avoid more cases of imported infection by many countries during the pandemic, but these measures mean that most migrant populations, including migrates, migrant and seasonal workers, international students, and others, have to stay in their host nations. Therefore, equitable access to health and social services in their migrant-receiving areas is crucial, and the World Health Organization specifically issued guidance to Member States and partners calling for the inclusion of migrants and the removal of any excessive out-of-pocket payments for COVID-19-related health services.1 However, host nations may encounter a dilemma when considering their policy responses. On the one hand, these changes would allow migrant populations to benefit from limited and valuable medical resources, even free medical services, designed for local residents. On the other hand, the exclusion of migrant populations from the welfare system and public health services, such as free testing, diagnostics, care, and treatment, would increase the risk of outbreaks in these populations [1] and present an additional threat to local public health due to the externalities of the pandemic [2–4]. In this context, it is vital to understand public attitudes towards migrant populations’ access to public health services and welfare benefits, as these attitudes explain policy responses [5–8].
The current study was conducted in China, where the COVID-19 pandemic first emerged. To flatten the curve of new cases over time, the Chinese government has taken several decisive actions since the end of January 2020. One of the most effective and dependable actions was the provision of free testing for local residents and the removal of excessive out-of-pocket payments for treatment. Treatment for COVID-19 costs an average of 17,000 yuan ($2,400) per patient, and 65% of the cost is covered by basic medical insurance [9]. In addition, in early February, China announced that the other 35% of COVID-19 patients’ medical costs would be subsidized by local governments. In other words, local residents would be offered “free treatment” for the disease.
One of the most controversial topics in China is whether migrates should be given the same free treatment as local residents. The number of foreign immigrants in China is relatively small due to the country’s strict immigration control policy [10]. Yet, there is a significant number of Hong Kong residents living in Mainland China, especially in Guangdong Province, which borders Hong Kong. Based on the special institutional arrangement of “one country, two systems,” Hong Kong’s financial system and social security system are independent of those in Mainland China. Therefore, Hong Kong residents are usually considered migrant populations when they move to Mainland China. Recently, with the national strategy of the construction of the Guangdong-Hong Kong-Macao Greater Bay Area and a series of favorable policies for cross-border living and working, more and more Hong Kong residents have chosen to reside in Guangdong. Figures from the Hong Kong government show that there were about 542,000 Hong Kong residents in Guangdong in mid-2019, and most of them were older adults and children (see Table 1) [11]. During the current outbreak of COVID-19, some Hong Kong residents were also infected with the virus, and the debate about whether they should get the free treatment has aroused widespread public attention. Given this context, this study will investigate Guangdong residents’ attitudes towards Hong Kong people’ access to local public health services and welfare benefits.
Table 1
Hong Kong residents in the Guangdong Province (2013–2019)
Reference
time point
|
Age group
|
Total
|
0–14
|
15–24
|
25–44
|
45–64
|
≥ 65
|
Mid-2013
|
220,100
|
19,600
|
71,900
|
137,400
|
67,600
|
516,700
|
Mid-2014
|
218,800
|
21,000
|
70,400
|
135,700
|
70,900
|
516,600
|
Mid-2015
|
218,700
|
22,000
|
68,300
|
134,000
|
73,100
|
516,000
|
Mid-2016
|
220,500
|
23,000
|
68,400
|
134,000
|
75,200
|
521,000
|
Mid-2017
|
223,800
|
24,500
|
70,100
|
135,200
|
77,400
|
531,000
|
Mid-2018
|
220,700
|
26,400
|
72,600
|
137,100
|
81,000
|
537,700
|
Mid-2019
|
199,000
|
28,700
|
76,400
|
147,600
|
90,200
|
541,900
|
Source: Commissioner for Census and Statistics, 2020.
Given this context, this study will investigate Guangdong residents’ attitudes towards Hong Kong people’ access to local public health services and welfare benefits. This study proposes two key research hypotheses based on a literature review.