# The association between confidence in health system and self-rated health: from the perspective of regional comparison

## TL;DR

Confidence in China's health system, especially in affordability, is linked to better self-rated health, with stronger effects in rural and western regions.

## Contribution

This study identifies regional and urban–rural differences in how health system confidence affects self-rated health in China.

## Key findings

- Higher confidence in healthcare accessibility and affordability is associated with better self-rated health in China.
- Affordability-related confidence has the strongest effect on health outcomes, particularly in rural and western regions.
- Both urban–rural and regional disparities highlight the need for equity-focused health policies.

## Abstract

Universal health coverage (UHC) aims to ensure that all people can access quality health services without financial hardship, and thereby improve health outcomes. Confidence in the health system reflects the individuals’ belief that they can obtain or afford care when ill. This study examined the association between health system confidence and self-rated health (SRH) across urban–rural and regional (western, middle, and eastern) areas of China.

Data were drawn from two waves of the Chinese General Social Survey that included 6,481 participants. Ordered logistic regression was used to assess the association between health system confidence and SRH. Subsample analyses and interaction models were used to explore regional heterogeneity.

Both self-rated health (SRH) and confidence in obtaining and affording healthcare were higher in urban and eastern regions. Greater confidence in the health system was positively associated with better SRH. Compared to the group without confidence, the group with confidence in getting (β = 0.394, OR = 1.483, p < 0.001) and affording (β = 0.645, OR = 1.906, p < 0.001) healthcare when needed had significant positive associations with better SRH. Confidence in both dimensions showed the strongest effect (β = 0.715, OR = 2.044, p < 0.001). Regarding heterogeneity, affordability-related confidence had particularly strong effects in western regions whereas both dimensions exerted larger effects in rural, compared with urban, areas.

Confidence in the health system—especially in affordability—is strongly associated with better health outcomes in China. Equity-oriented policies that strengthen both accessibility and affordability, with particular attention to disadvantaged regions and vulnerable populations, are essential for improving health equity.