The association between health care needs, socioeconomic status, and life satisfaction of a Chinese rural population cohort, 2012-2018

This study demonstrates that higher unmet health care needs were longitudinally associated with lower perceived SES and lower life satisfaction in the Chinese rural population. Health care needs are an independent predictor of long-term SES, even after adjusting for sociodemographic characteristics, health status, and individual lifestyle. Logistic regression model results confirmed that older rural residents with moderate or worse illness and comorbid chronic conditions were more likely to report having significant unmet health care needs. Our results suggest that health care needs involve important elements of individuals’ social well-being and health equity, a fact that has not received adequate attention in previous SES studies of rural populations. . Since the concepts of perceived SES and life satisfaction in this study were subjective, respondents’ mental well-being was also taken into account in our analysis and showed a significant impact on the effect. unmet health care needs on respondents’ SES. Mental health problems are associated with chronic physical illnesses and socioeconomic disadvantage in China19.20and the use of mental health services in rural areas is insufficient compared to that in urban areas21. We suggest that unequal access to health care is not just a health problem but a social problem and posit that it can increase social disparities within communities, between regions and even between generations. Future research will be needed to examine these mechanisms and develop possible interventions to reduce health-related social inequalities.

Met/unmet health care needs are increasingly identified as a key indicator of access to care within and between different health systems22.23. However, assessment results may vary due to different definitions, contexts, or populations of health care needs. In this study, we referred to health care needs as the difference between the health care services deemed necessary to manage a particular health condition and the services actually received, which is consistent with several previous studies.24.25. However, as health is increasingly viewed by the public health community as a multidimensional construct that includes the physical, mental, and social domains26, the connotations of health needs change and broaden accordingly. The significant association between unmet health care needs and low perceived SES and life satisfaction can be reasonably explained if we recognize health care needs as the health aspect of care needs social services, which aim to provide individuals with assistance in activities of daily living, in order to maintain their independence. , and enable them to better engage in social activities27. Long-term unmet needs have been confirmed to be more likely to lead to mental health issues28readmission29and high mortality rates30, which in turn reduces individuals’ SES and life satisfaction. Moreover, since China has a dual rural-urban system in which socio-economic disparity is large and urbanization has been rapid in recent decades, the gap between rural and urban areas in terms of population structure , social standards and economic development has widened. Reducing unmet health care needs is important to bridging the boundaries between social, mental and medical services for rural populations.

Social class has been confirmed by previous studies as a fundamental determinant of health, and the association is thought to be linked to cross-cultural and geographic boundaries. A close relationship between unmet health care needs and individuals’ SES has been reported in several previous studies. For example, people who are female, ethnic minority, low income, or have chronic conditions were more likely to report a high possibility of having unmet health care needs31,32,33,34. However, our data revealed that people reporting high unmet need were those who reported living with mild disease. Further analyzes also showed that people with unmet health needs were very likely to have unequal access to medical services. This phenomenon revealed that rural residents who did not consistently use health services may not have done so because of their mild illness, but because they lacked access to affordable quality medical services, which is partly in line with the previous conclusions.35,36,37 but has never been discussed in terms of China’s rural population. Further studies should explore the factors that contribute to unequal access to medical care, quantify their associations with unmet health care needs, and investigate their longitudinally detrimental effect on the SES of rural residents.

An interesting finding is that increased intakes in rural health facilities over the past few decades do not appear to have resulted in commensurate improvements in life satisfaction for rural residents. Satisfaction with life is identified as a subjective and difficult to measure concept. A previous study on life satisfaction indicated that simply assuming that rapid economic growth can lead to a happy population is not accurate.38. This study demonstrated a causal relationship between unmet health care needs and low life satisfaction in a rural population in China. China has experienced rapid and substantial economic growth for more than 30 years, and the NCMS provides health insurance coverage to rural people, which has significantly changed the health of rural people over time.39. However, a recent study found that Chinese rural residents from low-income groups still report high financial risk.40, resulting in a high rate of unmet health needs. Additionally, we found that despite improved satisfaction with the quality of healthcare services, an increased proportion of respondents reported being dissatisfied with the quality of healthcare services for all types of medical services in 2012 to 2018. This indicates that despite the existence of a causal relationship between unmet health needs and life satisfaction, the mediating effect of the quality of health services needs further investigation. The NCMS should gradually shift from increasing population coverage to improving service coverage and reimbursement rates. Rural residents are the most difficult population for which to improve health outcomes due to their low income, poor health status and limited access to health services41. Our results confirmed that unmet health care needs can be a detrimental factor leading to socioeconomic disadvantage and life dissatisfaction in China’s rural population, and its impact is consistent and far-reaching.

This study had several limitations. First, although our sample was obtained from a nationally representative sample, only data from approximately 1300 people, who met the purpose of our study, were obtained for analysis, which may have led to selection bias and affected the generalizability of our results. Second, information regarding SES and life satisfaction was self-reported, which may have resulted in recall bias. Third, even though respondents reported rural family register in 2012 and 2018, they may have been living in an urban rather than a rural area, and we cannot distinguish between these two groups in this study, which may have led to a selection bias.

Andrew B. Reiter