A multi-stage random sampling method was employed to select participants from the urban area of Xuzhou between October 2020 and May 2021, focusing on migrant older adults aged 60 years and above. In the first stage, 10 communities were randomly selected from each of the five administrative districts of Xuzhou: Tongshan District, Yunlong District, Gulou District, Quanshan District, and Jiawang District. In the second stage, 12 households were randomly chosen within each community. Finally, in the third stage, one migrant older adults individual was randomly selected from each household to participate in the offline questionnaire survey. A total of 600 questionnaires were distributed, of which 568 were deemed valid after careful scrutiny, yielding an effective response rate of 94.7%.

Inclusion criteria for participants were: migrant older adults aged 60 years and older, who had lived in the local area for at least 1 month, held foreign household registration, and provided informed consent to participate in the survey. Exclusion criteria included individuals in poor health, those with cognitive impairments, and those who were unwilling or unable to complete the questionnaire.

According to the definition in social medicine and health management textbooks, outpatient service utilization was assessed by determining whether the respondent had used outpatient services at a health center in the past 2 weeks. Inpatient service utilization was measured by whether the respondent had been hospitalized in the past year. Data were collected through face-to-face questionnaires. Additionally, awareness of and needs for health services were measured across 11 categories, including physical examinations, auxiliary examinations, chronic disease management, health education, interpretation of physical examination results, health guidance, follow-up, and review etc. Both health service awareness and needs were scored on a binary scale (Yes = 1, No = 0), with total scores ranging from 0 to 11.

The questionnaire was developed following Anderson’s Behavioral Model of Health Service Utilization and through a series of pre-surveys and team discussions. It included three main sections: (1) The first section was predisposition traits, mainly include gender, age, education level, marital status, children quantity, flow range and flow time among participants. (2) The second section was enabling resources, mainly include personal monthly income, pension insurance, access to healthcare services including health insurance availability and time to health centers. (3) The third section was need factors, mainly include self-assessed health status, the number of chronic diseases, sick for the past 2 weeks, their health services awareness, and their health needs.

Descriptive statistics were used to calculate the number and percentage of categorical variables, with proportions expressed as percentages for different classifications of each variable.

To explore the associations between various factors and healthcare service utilization, Chi-square tests were employed to assess the factors influencing health service utilization among migrant older adults. Multivariate logistic regressions were selected for analysis, which is particularly useful for identifying the associations between variables (25). Variables that demonstrated statistical significance in the univariate analysis were included in the logistic regression model to explore the determinants of healthcare utilization among the migrant older adults. For non-normally distributed data, such as health service awareness and health service needs, non-parametric tests were used, with results expressed in medians and quartiles. Statistical analyses were conducted using SPSS software (version 22.0), with a significance level of p < 0.05 (two-sided) considered statistically significant.

Table 1 shows a balanced distribution in gender, among 568 migrant older adults, with 285 (50.2%) males and 283 (49.8%) females, spanning an age range of 60 and 86 years, with a mean age of (66.9 ± 6.2) years. Within the sample, 434 participants (76.4%) were married. The majority, 366 (64.4%) possessed pension insurance and 496 (87.3%) possessed health insurance.

Table 1 also illustrates the healthcare service utilization among the 568 migrant older adults participants. A total of 73 participants (12.9%) reported using outpatient services at health centers in the past 2 weeks. The analysis revealed significant differences in outpatient service utilization based on several variables. In the predisposing traits category, only education level showed statistical significance. In the enabling resources category, factors such as pension insurance, convenience to visit, and time to health centers were significant. Finally, in the need factors category, self-assessed health status, the number of chronic diseases, sick for the past 2 weeks, and health service needs were all significantly associated with outpatient service utilization (p < 0.05).

Regarding inpatient services, 109 participants (19.2%) reported being hospitalized in the past year. The analysis showed significant differences in inpatient service utilization based on age, marital status, education level, and number of children in the predisposing traits category. In the enabling resources category, variables such as personal monthly income, pension insurance, health insurance, convenience to visit, and time to health centers were significantly associated with inpatient service utilization. The need factors of self-assessed health status, the number of chronic diseases, sick for the past 2 weeks, and health service needs also showed statistical significance (p < 0.05).

The study found that, among the 568 participants, only 73 individuals (12.9%) utilized outpatient services within the past 2 weeks. This rate is considerably lower than the average outpatient service utilization for migrant populations in the province (20.42%) (26, 27), and also below the national average for older adults populations (20.9%) (28, 29). In the past year, inpatient services were utilized by 109 migrant older adults (19.2%), which is again lower than the rates reported in most recent studies (29.9%) (30, 31). This discrepancy can be attributed to the fact that a large proportion of the sample (73.2%) consisted of migrant older adults aged 60–69, who generally enjoy relatively good health and exhibit fewer evident healthcare needs, thereby lowering their utilization rates (32).

Additionally, limited health awareness among the migrants and a lack of understanding of healthcare services at their destination may lead them to rely on purchasing medication from pharmacies or even avoid seeking medical attention when experiencing discomfort (33). These factors contribute to the relatively low healthcare service utilization observed in this study. The findings suggest, on one hand, a lack of disease knowledge and insufficient attention to personal health among the migrant older adults in Xuzhou, pointing to the need for improved health education. On the other hand, they highlight the limited understanding of available health services, underscoring the importance of strengthening health promotion efforts targeting migrant populations. Furthermore, it is recommended that migrant older adults be included in health management through community health service centers in order to promote more effective health services utilization.

Among the three characteristics in Anderson’s model, enabling resources and need factors exert the most significant influence on outpatient service utilization among migrant older adults. Predisposing traits play a limited role, with one exception: migrant older adults with higher education levels (college or above) tend to develop a stronger sense of health awareness (34, 35), which correlates with a reduced likelihood of utilizing outpatient services. These individuals often possess basic medical knowledge and have a better understanding of their health conditions (16), leading them to prefer purchasing medications from pharmacies or using medicines brought from their hometowns to manage minor health issues (36).

At the enabling resources level, outpatient service utilization is higher among those with pension insurance and convenient access to healthcare services. Conversely, migrant older adults who need to travel more than 60 min to reach a health center show significantly lower utilization rates. Pension insurance plays a pivotal role in providing financial security, supporting basic healthcare needs (16), and promoting the utilization of outpatient services. However, the underutilization of outpatient services among those with long travel times highlights the critical impact of accessibility and convenience on healthcare utilization (21–23). The mobility of migrant older adults across provinces or regions introduces challenges such as varying medical policies, lifestyle differences, language barriers, and limited access to resources, prompting many to rely on self-medication or informal care for minor ailments (37, 38). Implementing comprehensive health management for migrant older adults could help ensure more equitable and efficient access to healthcare services.

Previous studies have also emphasized the predictive power of need factors in determining healthcare service utilization, particularly among the older adults (39–41). For outpatient services, good self-assessed health status is associated with lower utilization, while recent illness (within the past 2 weeks) increases the demand for healthcare services. Migrant older adults in good self-assessed health are less likely to engage with healthcare services, as their health status accurately reflects their overall wellbeing (42–44). Migrant older adults with poor self-assessed health status tend to have a subjective perception of their own health status (45), thereby increasing the likelihood of accepting outpatient medical services. Migrant older adults with high health service needs typically exhibit varying degrees of physical or mental impairment or are in a suboptimal state of health, leading to an increased inclination to utilize healthcare services (46). Moreover, the attribute of mobility can further exacerbate concerns about their health status among migrant older adults, potentially resulting in a psychological burden and consequently driving them toward seeking healthcare services (47). Consequently, the impact of the mental health and health awareness of migrant older adults people in the field of health can be targeted in subsequent research.

In addition to outpatient services, predisposing traits significantly influence inpatient service utilization, particularly among migrant older adults aged 80 and above, who demonstrate much higher utilization rates than their younger counterparts (aged 60–69). This increase is likely due to the natural aging process and the associated decline in physiological functioning (48, 49) as well as the inverse relationship between age and overall health status (49, 50), leading to a greater demand for inpatient care (50, 51). With advancing age, the prevalence of chronic diseases rises (52, 53), further increasing the need for inpatient services. Previous research has documented the high prevalence of chronic diseases among the older adults in Xuzhou (54), and migrant older adults with multiple chronic conditions exhibit significantly higher utilization of inpatient services compared to those without such ailments (55). Chronic diseases such as hypertension and diabetes, which often lead to debilitating complications, profoundly affect the quality of life for migrant older adults and drive their reliance on inpatient care (56, 57).

Among enabling resources, limitations in Medicare coverage and pension income restrict the utilization of residential health services by migrant older adults. This study highlights the significant impact of health insurance coverage on healthcare utilization (58). The low reimbursement rates for hospitalization expenses at the destination, coupled with complex reimbursement procedures and limitations on eligible services, create barriers to inpatient healthcare access for migrant older adults (49, 59). Socioeconomic factors also contribute to disparities in healthcare utilization, as migrant older adults often face financial instability due to inconsistent incomes (60, 61). However, pension insurance can reduce reliance on offspring for healthcare costs, especially for hospitalization, which can incur substantial expenses (26). Conversely, migrant older adults without pension or health insurance are less likely to utilize healthcare services. To address these challenges, enhancing the development of medical insurance information systems is crucial for facilitating cross-regional medical expense settlements. Additionally, efforts should be made to promote commercial health insurance as a supplementary option for migrant older adults. Expanding the scope of reimbursement and increasing hospitalization coverage rates can alleviate financial burdens and ultimately improve healthcare utilization among this population (62).

This study is subject to several limitations that should be acknowledged. First, the cross-sectional design limits the ability to establish causal relationships regarding healthcare service utilization among the migrant older adults. Second, this study’s geographic focus on Xuzhou City may introduce regional biases, as the findings are influenced by the specific characteristics and healthcare landscape of this area. Third, we did not collect data on key variables such as social integration, familiarity with the healthcare system in the destination, or the existence of personal health records, and their absence limits the depth of our analysis regarding the influences on healthcare services utilization. Despite these limitations, our study provides a foundation for future research and offers valuable insights for improving the utilization of healthcare services.