High Medical Costs and Resource Shortages Constrain Rural Happiness More Than Physical Access in Rural China

He, Yuchen, Jin, Shan and Chen, Jing (2026) High Medical Costs and Resource Shortages Constrain Rural Happiness More Than Physical Access in Rural China. Frontiers in Public Health. ISSN 2296-2565 (In Press)

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Abstract

Access to healthcare services is closely associated with people’s subjective well-being (SWB). To address the country’s urban-rural healthcare gap, the Chinese government has implemented large-scale reforms in rural areas to improve access to basic health services. Although a growing body of research has examined the relationship between healthcare accessibility and SWB in rural contexts, variations across different rural regions remain underexplored. To address this gap, this study investigates the association between multidimensional healthcare accessibility—specifically affordability, availability, and geographic accessibility—and the SWB of rural residents in China. Data were collected through face-to-face surveys with 589 rural residents from two counties—one in Jiangsu Province and one in Jiangxi Province—representing economically developed and less-developed rural regions, respectively. The results reveal that affordability and resource availability are significantly associated with rural residents’ happiness, whereas geographic distance from healthcare provision is no longer a primary constraint due to widespread infrastructure improvements. Crucially, the statistical mediation pathways through physical and mental health exhibit significant regional heterogeneity. In the less economically developed region, the availability of medical resources acts as a psychological safety net that is linked to reduced anxiety. In contrast, in the economically developed region, affordability constraints are linked to reduced happiness predominantly through the depreciation of physical health capital, reflecting a tangible constraint on maintaining expected health standards. Public health governance should transition from universal spatial expansion toward precision-driven interventions which focus on medical expenditure and service quality, in order to better support the happiness of diverse rural populations.

Item Type:	Article
Keywords:	accessibility, happiness, Healthcare service, medical, Rural residents
Divisions:	Land and Property Management
Depositing User:	Dr Andy Jin
Date Deposited:	30 Apr 2026 16:44
Last Modified:	30 Apr 2026 16:44
URI:	https://rau.repository.guildhe.ac.uk/id/eprint/17099

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