Language barriers and the uptake of basic public health services among internal migrants in China

The large-scale movement of internal migrants in China poses significant challenges to the equitable provision of basic public health services (BPHS). While linguistic differences are widely recognized as structural hurdles to healthcare access, existing literature often treats them as a monolithic concept. This study examines the association between language barriers and BPHS uptake by disaggregating these barriers into two distinct dimensions: an institutional barrier, reflecting the linguistic distance to the national standard language (Standard Mandarin), and a social barrier, reflecting the linguistic distance to the local dialect. This study utilized micro-level data from the 2017 China Migrants Dynamic Survey (CMDS), focusing on a sample of 28,245 migrants originating from regions where Standard Mandarin is not the native dialect. We measured the institutional language barrier using the Automated Similarity Judgment Program (ASJP) methodology and quantified the social language barrier based on hierarchical dialect classifications. To rigorously estimate the associations between these barriers and two distinct BPHS outcomes (health record establishment and health education receipt), we employed Probit regression models incorporating comprehensive covariates, alongside city-level and industry fixed effects. We report average marginal estimates to ensure strict comparability. The analysis reveals a nuanced dual-track pattern of association. A lower probability of taking up formal administrative services, such as establishing a health record, is significantly associated with both institutional and social language barriers. In contrast, lower participation in community-based interactive services, such as health education, correlates predominantly with the social language barrier. Crucially, interaction analyses demonstrate that the institutional and social barriers operate as parallel and independent constraints, rather than exacerbating one another. Furthermore, moderation analysis indicates that higher educational attainment helps buffer the negative associations of severe structural dialect distances. These findings challenge the monolithic view of language barriers, suggesting that the relevant structural linguistic constraint depends fundamentally on on the nature of the health service. Because institutional and social language distances function as independent structural hurdles, policy interventions must adopt a dual-pronged strategy to separately address the structural hurdles associated with institutional and local dialect distances, thereby promoting public health equity for migrant populations.