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. 2025 Jun 19:13:1581130.
doi: 10.3389/fpubh.2025.1581130. eCollection 2025.

Social medical insurance system and self-rated health: medical service utilization as the mechanism of action

Jian Zhou  1 , Mingjing Li  1 , Yucui Lv  1
Affiliations

Social medical insurance system and self-rated health: medical service utilization as the mechanism of action

Jian Zhou et al. Front Public Health. .

Abstract

Background: The fragmented segmentation of the health insurance system has led to differences in healthcare utilization and health outcomes among enrollees with different types of health insurance. This study aims to evaluate the impact of different health insurance system and further explore the pathways of health insurance.

Methods: Using data from the Chinese Family Panel Studies (CFPS) conducted by the China Social Science Survey Center of Peking University in 2018 and 2020, this study employed logit regression model to estimate the impact of different types of health insurance systems on health outcomes. Additionally, healthcare utilization was introduced as a mechanism variable for analysis.

Results: The findings indicate that Urban and Rural Residents Basic Medical Insurance (URRBMI) does not significantly improve health outcomes. In contrast, Urban Employee Basic Medical Insurance (UEBMI) significantly enhances the health status of insured individuals. The influence of medical insurance systems on health exhibits heterogeneity, with education level and regional disparities significantly affecting the effectiveness of these systems. Patterns of healthcare utilization, including inpatient and outpatient medical expenditures and the use of large hospitals, play a crucial role in enhancing the health of insured individuals under UEBMI.

Conclusion: There are significant differences in the impact of various medical insurance systems on the health of insured individuals. UEBMI demonstrates a superior effect in improving the health of insured individuals compared with URRBMI. Future efforts should focus on enhancing the overall planning and coordination of medical insurance, narrowing benefit disparities, and promoting the implementation of a tiered medical system.

Keywords: health equity; healthcare utilization; self-rated health; urban and rural residents basic medical insurance; urban employee basic medical insurance.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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