Health Services Accessibility and Self-Reported Health Among Chinese Middle-Aged and Older Adults: Propensity Score Matching and Mixed-Effects Ordinal Logit Analysis.

This study evaluates the impact of unmet healthcare needs on self-reported health among middle-aged and older Chinese adults (≥45 years), with a focus on urban-rural disparities. Using 2011, 2013, and 2015 CHARLS data, we applied propensity score matching and mixed-effects ordinal logit models, with interaction effects regression for urban-rural differences. We analyzed the impact of unmet healthcare needs-defined as instances where individuals perceived a need for medical care but did not receive it-on self-reported health, which was measured using a 5-point Likert scale. Unmet outpatient care alone did not significantly affect self-reported health but had a negative impact when financial barriers were present (AOR = 0.44, 95% CI = [0.24, 0.82]). Unmet inpatient care significantly decreased self-reported health (AOR = 0.65, 95% CI = [0.57, 0.74]), with financial barriers worsening the effect (AOR = 0.25, 95% CI = [0.15, 0.42]). The negative impact of unmet inpatient care was significant only for rural residents (AOR = 0.67, 95% CI = [0.50, 0.89]). Unmet healthcare needs, particularly due to financial barriers, significantly harm self-reported health, with rural populations more affected, highlighting the need for targeted reforms in both financial protection and healthcare system delivery.