ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1656639
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 96 articles
The Association Between Confidence in Health System and Self-rated Health
Provisionally accepted
Zhaoxi Wang1
Kairan Zhang2*- 1Northwest University, Xi'an, China
- 2Northwest University of Politics and Law, Xi'An, China
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Background: 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. Method: 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. Results: Both self-rated health (SRH) and confidence in obtaining and affording care 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. Conclusion: 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.
Keywords: confidence in health system, affordability confidence, accessibility confidence, self-rated health, regional comparison
Received: 30 Jun 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Wang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kairan Zhang, zkrworkaffair@163.com
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