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The association between digitalization and individual health has attracted increasing attention from both scholars and policymakers. Existing research, however, has not agreed on whether digitization can improve health or reduce health inequality. The purpose of this study is to clarify whether and how the development of digitalization may be related to health and health disparities. We rely on China Family Panel Studies (CFPS) surveys from 2012 to 2018 to obtain a sample of 82,471 observations to explore the impact of digitalization on self-rated health and health inequality and its transmission mechanisms. The hypotheses are tested by Ordinary Least Squares Modeling. As expected, digitalization is significantly and positively correlated with self-rated health. Furthermore, the development of digitalization has led to a notable decrease in health inequality. The influencing mechanisms of digitalization include income, healthcare consumption and health behaviors. Both dimensions of digitalization—internet development and digital finance—generate significant effects and the effects of internet development are greater. This study is the first to systematically investigate the impact of digitalization development on health and health inequality. Our findings provide evidence for the health promotion theory by clarifying the benefits of digitalization in improving residents' health and reducing health inequality. Therefore, utilizing the tools of digitalization efficiently could be a focus of policymakers aiming to accomplish the SDGs' health targets. • This paper contributes to assess the health outcomes of digitalization in China. • Developing digitalization has greatly improved self-rated health of residents. • Also, digitalization has reduced health inequality between residents. • Digitalization can affect health through income, health consumption and behaviors. • Digitalization is a useful tool for policymakers to reach the SDGs' health goals. [ABSTRACT FROM AUTHOR]

Highlights • This paper explores the effects of four dimensions of social exclusion on self-rated health and depression among older people in China. • Lower level of exclusion from social relationships was associated with less likely to report fair or poor SRH. • Lower level of subjective feelings of exclusion was associated with less likely to report fair or poor SRH. • Lower level of subjective feeling of exclusion was associated with less likely to report depression. • Lower level of exclusion from financial products was associated with less likely to report depression. Abstract Background It is well established that social exclusion is a key social determinant of health; however, such association between social exclusion and health outcomes among older people remain a relatively under-researched area. This paper explores the effects of four dimensions of social exclusion on self-rated health and depression among older people in China. Methods This paper includes 8038 individuals aged 60 and over from the first wave national multi-stage probability sample (2014) from the China Longitudinal Aging Social Survey (CLASS). Descriptive univariate information for individual variables and four dimensions of social exclusion are presented. Multinomial and binary logistic regression models are used to examine the associations between social exclusion and self-rated health and depression. Results Older people who were in the lower level of exclusion from social relationships or subjective feelings of exclusion were significantly less likely to report fair or poor self-rated health than people in the higher level of exclusion (lower level of exclusion from social activities was significantly associated with being less likely to report poor SRH only). Older people who were in the lower level of subjective feeling of exclusion or exclusion from financial products were significantly less likely to report depression. Conclusions Different dimensions of social exclusion have different effects on self-rated health and depression. Social policies need to reflect this and efforts of services could usefully be oriented to prevent multi-dimensions of social exclusion. Ultimately, such policies should have the potential to enhance the health of older people in China. [ABSTRACT FROM AUTHOR]

China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-of-pocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low- and medium-income individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system. [ABSTRACT FROM AUTHOR]

Previous studies have not paid enough attention to the effect of health on urban-settlement intention of rural-urban migrants in China. Using survey data from the Rural Urban Migration in China project, this article examines how self-rated physical and mental health influence rural-urban migrants' intention to settle down in cities. First, the results show that both self-rated physical and mental health are significant factors influencing the migrants' intention to permanently move to cities. Second, the effect of physical health on rural-urban migrants' intentions to permanently reside in cities can be moderated by their length of urban residence. Third, the impact of health on rural-urban migrants' urban-settlement intention shows no generational differences. According to the research findings, this paper discusses how urban-settlement intention of rural-urban migrants based on health selection might impair urbanization, exacerbate health disparity between the rural and urban areas, and aggravate the burden on healthcare system in rural areas of China in the long run. [ABSTRACT FROM AUTHOR]

Despite increasing evidence that social capital is positively associated with health, the pathways that link social capital to health are not definitive and invite further investigation. This paper uses household survey data from 22 villages in China in 2002 to test the relationship between social capital and the self-reported health status of the rural population. Focusing on the cognitive dimension of social capital, this paper complements current social capital research by introducing an overlooked distinction between trust and mistrust. Trust and mistrust are measured at the individual and aggregate levels, and the distinct ways in which they affect general and mental health are explored. We adopt an ordered logistic regression using survey procedures in SAS version 9.1 to account for the stratified and clustered data structure. The results suggest that: (1) individual-level trust and mistrust are both associated with self-reported health in rural China – trust is positively associated with both general health and mental health, while mistrust is more powerfully associated with worse mental health; and (2) the effects of individual-level trust and mistrust are dependent on village context – village-level trust substitutes for individual-level trust, while individual-level mistrust interacts positively with village-level mistrust to affect health. However, an unexpected protective health effect of mistrust is found in certain types of villages, and this unique result has yet to be examined. Overall, this study suggests the conceptual difference between trust and mistrust and the differential mechanisms by which trust and mistrust affect health in rural China. It also suggests that effective policies should aim at enhancing trust collectively or reducing mistrust at the personal level to improve health status in rural areas of China. [Copyright &y& Elsevier]

This paper investigates whether childhood conditions affect survival and health, both directly and indirectly through the mediating variable of adulthood socioeconomic status, among Chinese elderly. Using data from the 2008–2009 and 2011–2012 waves of the Chinese Longitudinal Healthy Longevity Survey, we apply structural equation models to estimate these effects. We find that favorable childhood conditions exert a negative direct impact on survival probability at senior ages, possibly resulting from mortality selection. Our results also support the pathways model, which indicates that advantageous childhood conditions improve socioeconomic status in adulthood and thus indirectly promote longevity and health at advanced ages. Combining the direct and indirect effects, the total effects of childhood advantages on survival and health are positive. We further demonstrate that direct and indirect effects of childhood conditions are stronger for women than they are for men. Our findings suggest that public policies that target childhood wellbeing may have far-reaching protective impacts on health among seniors. [ABSTRACT FROM AUTHOR]

There is an increasing interest in using ordinal data collection methods, such as the best-worst scaling (BWS), to develop preference-based tariffs (value sets) for health-related quality of life instruments, yet the evidence on their performance is limited. This paper proposed to use an anchored BWS technique (in which the state of "death" served as an anchoring state) to directly develop a utility weight that lies on a scale anchored at 0 = death and 1 = full health for the Simplified Chinese version of the Short Form 6 Dimension version 2 (SF-6Dv2). An online panel from the general population of Mainland China completed an online survey between 20th July and 19th August, 2019 and 463 respondents were included in the main analysis. The Conditional Logit (CL) model, which assumes a homogeneous preference, as well as a Hierarchical Bayes (HB) model, which accounts for preference heterogeneity, were used to analyze the BWS data. The model performances were evaluated based on monotonicity and model-fit statistics. The majority of respondents indicated that the BWS questions were easy to understand and complete. Initial analyses suggested that the best and worst choices should not be pooled together. Based on model fit statistics of separated estimations and previous literature on health state valuation studies using BWS, the best choices were used for developing the final algorithm. The HB estimates were found to have better model performance than the CL estimates. This study provides an essential insight into using an anchored BWS approach in health state valuation. Furthermore, it demonstrates the advantage of using HB compared to the traditional CL model in producing preference values. • An anchored best-worst scaling technique has been used to develop preference weights directly. • Accounting for individual heterogeneity leads to a better model fit. • Incorporating respondents' views of attribute importance can improve model performance. • A Chinese online-panel-based scoring algorithm for SF-6Dv2 is developed. [ABSTRACT FROM AUTHOR]

It is widely recognized that China has experienced the largest internal migration in its history and that these internal migrants are largely excluded from urban services, posing major challenges to their health outcomes. This paper attempts to address this issue from a socio-ecological lens, examining John W. Berry's conceptual framework of acculturation on internal migrants' health in China. We employed the National Migrant Dynamic Monitoring Survey (MDMS; 2014) data, with around 16,000 samples from eight cities. Our results showed that compared to their hometown culture, where migrants can successfully integrate into the mainstream culture of the destination area, mental health stress can be prevented and self-assessed health status is improved. Well-integrated migrants showed the best self-reported health (SRH) and mental health status, while segregated or marginalized migrants received lower health scores. It was interesting to see that the origin culture only protected SRH whereas the local culture could promote both mental health and SRH. This evidence may be alarming. Local government must respect origin cultures when carrying out social integration policy. In addition, macro-migration policies should encourage local mobility within the same cultural areas to minimize the negative effects of migration. • Applied John W. Berry's framework to urban-to-urban and rural-to-urban migration. • Attitude towards host culture and origin culture impacts internal migrants' health. • Cultural distance is linked with the selection of acculturation strategy. • Local governments should respect migrants' origin culture in policy development. [ABSTRACT FROM AUTHOR]