The Impact of Social Health Insurance Quality on Intergenerational Medical Support for Older Adults

The Impact of Social Health Insurance Quality on Intergenerational Medical Support for Older Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Social Health Insurance Quality on Intergenerational Medical Support for Older Adults Chi Zhang, Longxuan Lin, Xiaoyu Han, Hengyuan Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7600300/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background The study addresses the growing concern of intergenerational support for the older adults amidst China's rapidly aging population and changing family structures. Methods The research utilizes data collected from 1,882 valid questionnaires administered to individuals across China's eastern, central, and western provinces in 2019 and 2021. Regression and mediation effect analyses were conducted to examine the impact of social health insurance quality on intergenerational healthcare support. The study also explores the mediating role of urban-rural differences and the socioeconomic status of older adults in this impact. Results Social health insurance coverage is negatively associated with intergenerational health care cost support for the older adults, indicating that the social health insurance system plays a positive role in reducing the financial burden of family health care. Further analysis reveals that the impact of social health insurance quality on intergenerational medical support differs significantly between urban and rural areas, with the crowding-out effect being more pronounced in urban areas. The socioeconomic status of the older adults has a significant impact on the degree of intergenerational health care support, and the "crowding out" effect of social health insurance quality on intergenerational health care support is stronger among the older adults with higher socioeconomic status. The "crowding-in" effect of social health insurance quality on intergenerational health care support and intergenerational psychosocial support is stronger for older adults with higher socioeconomic status. Finally, the study found that the economic and health performance of social health insurance mediated the improvement of intergenerational health care support for the older adults. Conclusion The study concludes that optimizing the social health insurance system requires the formulation of differentiated insurance policies that consider the different socioeconomic backgrounds of older adults. Strengthening the coordination of urban and rural social health insurance policies is suggested to narrow the service gap and upgrade the level of health insurance in rural areas. Social Health Insurance Quality Intergenerational Medical Support Urban-Rural Differences Older adults Figures Figure 1 1. Introduction As the global population experiences an increase in the proportion of older people and a shift in family structures, the intergenerational support needs of older groups are increasing. This is in conflict with the employment pressures induced by the uneven economic development of young people. This has created an intergenerational support problem that needs to be resolved urgently[ 1 ]. In the People's Republic of China, this problem is especially acute. The 2022 National Bulletin on the Development of the Aging Career reveals that by the end of 2022, the country had a total of 209.78 million older adults aged 65 and above, constituting 14.9% of the total population and exhibiting a dependency ratio of 21.8%. The Guiding Opinions on Promoting the Integration of Healthcare and Older Adults Care advocate the provision of integrated healthcare and older adults care services, with the aim of accelerating the integration of healthcare with the social and medical support required by older adults, thereby addressing the need for such support[ 2 ]. Following the implementation of reforms and the introduction of market-driven economic policies, China has witnessed a consistent enhancement in the scope and quality of its social health insurance coverage[ 3 ]. Recent studies have demonstrated significant advancements in the social support systems available to older adults in China, when compared with previous decades. However, research findings also indicate the presence of a robust intergenerational solidarity within Chinese society. Adult children's provision of intergenerational support to their parents remains the most significant resource for older adults in China, while intergenerational medical support has emerged as the most substantial component of the social and medical support framework available to this demographic[ 4 ]. 2. Literature Review and Theoretical Foundations (1) Social health insurance Social health insurance constitutes a pivotal component of the social security system. Its fundamental objective is to furnish financial protection to the insured in the event of medical expenses, utilising the mechanism of pooled risk sharing[ 5 ]. As fundraising groups grew, this form evolved into a more stable and widespread social health insurance system[ 6 ]. As the 19th century drew to a close, the advent of private insurance in Western Europe rendered social health insurance a pivotal means by which the state could finance healthcare[ 7 ]. Today, it has evolved into two categories: commercial insurance and universal social health insurance[ 8 ], The present study concentrates on the branch of universal social health insurance, and all subsequent references to social health insurance pertain to policy-based, universal social health insurance. Universal social medical insurance constitutes a social medical security system that provides extensive coverage and guarantees fairness for all individuals. Its principal feature is to ensure that all people have access to basic health services, especially vulnerable and low-income groups, through a uniform system design. The most typical inclusive social medical insurance in China is the medical insurance for urban and rural residents, and individuals can be guaranteed as long as they pay relatively low(lower than other forms of insurance, such as employment-based or private insurance[ 9 ]) medical insurance fees. The financing of this system is predominantly public, stemming from the socialist commitment to ensuring medical fairness, thus justifying its categorization as a form of social medical insurance. Social health insurance fulfils a dual role within the economic system, functioning as both a financial instrument and a social security mechanism. This duality is underpinned by the principles of fairness and justice, which serve as fundamental values within the societal context[ 10 ]. The social health insurance system has been demonstrated to exert a favourable influence on the healthcare service market. This influence is characterised by an augmentation in demand for healthcare services, which in turn serves to promote an equilibrium between supply and demand within the healthcare sector[ 11 ]. The multifaceted nature of social medical insurance, encompassing entities such as insurance companies, organisations, policyholders and medical institutions, gives rise to a sophisticated insurance ecosystem. The intricacies of this ecosystem, including its interactive components, the dynamics of supply and demand, risk management and associated concerns, constitute pivotal subjects for academic inquiry[ 12 ]. The number of individuals enrolled in China's social medical insurance scheme is increasing, yet disparities in healthcare access persist, particularly in rural regions. This phenomenon underscores the existing socio-economic and geographical disparities between urban and rural communities[ 13 ]. Moreover, the efficient functioning of the social health insurance system is contingent upon an adequate fund balance. However, the issue of fund imbalance is pervasive throughout the country[ 14 ]. The present study focuses specifically on social health insurance rather than commercial insurance for several reasons. First, in China, social health insurance—such as Urban Employee Basic Medical Insurance and Urban and Rural Resident Basic Medical Insurance—is the predominant form of medical coverage for the older population, with near-universal enrollment among older adults. In contrast, commercial insurance plays a supplementary role and remains underutilized, especially among low-income and rural elderly populations. Second, social health insurance is state-regulated and collectively financed, reflecting broader institutional and redistributive mechanisms that influence intergenerational support patterns. Third, social health insurance is subject to policy reforms and quality variations across regions, making it a more suitable focus for examining policy-driven disparities in intergenerational healthcare support. Therefore, this study concentrates on the quality dimensions of social health insurance—namely treatment satisfaction and equity perception—to evaluate its nuanced role in shaping family-based support structures among older adults. (2) Intergenerational support Intergenerational support can be defined as the transfer of material and spiritual resources between older adults aged 60 and over and their adult children. The concept has its origins in family studies and gerontological research, and has gained prominence with the accelerating global aging process and changes in family structure. The practice of mutual support, encompassing financial, emotional, and practical assistance, occurs across generations within a family unit or a more expansive social network[ 15 , 16 ]. Not only does it enhance individuals' social connections and improve quality of life and psychological well-being at the individual level[ 17 ], but it also serves to maintain family relationships, enhance family cohesion, and provide stress resilience support at the family level[ 18 ], At the societal level, intergenerational support also plays a significant role. From a social perspective, it is evident that intergenerational support fosters the rational allocation and utilisation of community resources, thereby enhancing community cohesion and stability[ 19 ]. Social exchange theory posits that intergenerational support is predicated on the principles of reciprocity and exchange. The theory is predicated on the premise that all human behaviour is driven by some form of reward or punishment[ 20 ]. In the context of intergenerational relationships, the concept of rewards and punishments is manifested through the dynamics of mutual support and reciprocity among family members. The principle of reciprocity governs the expectation that each generation will receive some form of reward from the other, which can manifest in material or spiritual forms[ 21 ]. From this standpoint, intergenerational support can be regarded as a form of investment. The assistance that parents provide to their offspring during the parenting process can be conceptualised as a "capital investment" in their children. This investment accrues a return as the children mature and the parents grow older[ 22 ]. Social health insurance has been demonstrated to play a role in coordinating public and private intergenerational wealth flows, facilitating the alignment of social support with intergenerational support, especially intergenerational health support, to enhance the quality of life and well-being of older adults. The bi-directional nature of intergenerational support is particularly pronounced in Chinese society. In contrast to the Western "relay" model of unidirectional, cyclical intergenerational support, Chinese intergenerational support relationships are a "feedback" model of bi-directional obligations[ 23 ]. It has been posited that within East Asian societies, where filial piety predominates, parents' intergenerational support is significantly more pronounced than that received from their children, owing to a confluence of factors including family transmission, emotional values, and cultural traditions such as the "joy of family", "social face", "social responsibility", and the "joy of family"[ 24 ]. The considerations of "social face", "child-rearing for old age", and "succession" can be viewed as a reciprocal exchange of economic and psychological comfort values[ 23 ]. The increased involvement of social health insurance has been demonstrated to have a number of notable consequences. Firstly, it has been shown to increase the level of social support for older adults. Secondly, it has been demonstrated to improve the economic and health status of older adults. Thirdly, it has been demonstrated to increase the likelihood that parents will return intergenerational support to their children, especially intergenerational medical support. Finally, it has been demonstrated to similarly strengthen the intergenerational support provided by children to their parents[ 25 ]. Specifically, social health insurance interventions have different impacts on the financial support, medical care support, and psychological support provided by children[ 26 ], and the specific utility of social health insurance is also closely related to the older person's own situation[ 27 ]. In the context of China's real-world circumstances, there is a divergence between the actual outcomes of the implementation of social health insurance policies and the idealised model. Furthermore, there are evident disparities in the effectiveness of these policies between urban and rural regions[ 28 , 29 ]. Nonetheless, there are certain institutional deficiencies in the process of promoting the popularisation of social health insurance. Furthermore, there are urban-rural differences in the impact of social health insurance on the financial support provided by children to their parents[ 30 ]. The amount that is paid back to people with insurance is very different in urban areas. This means that the amount of help that people with insurance get from their families is not getting better. In rural areas, most of the people who are attracted to the scheme have lower to middle incomes, poorer health and are more likely to have insurance programmes with shorter payback periods, which makes it difficult to achieve a positive cycle of long-term health improvement for the insured[ 31 ]. In addition, in the medical process, the level of prognosis that the medical process can provide varies due to the level of medical facilities and services in urban and rural areas[ 32 ], so there is a problem of the quality of urban and rural social health insurance has a large difference in the impact of the standard of living of the older adults, and the limited role of intergenerational support imbalance produced by the improvement of the role of the older adults . Based on this, this study proposes research hypothesis A: There is an urban-rural difference in the effect of social health insurance quality on intergenerational health care support. In addition, social capital theory posits that social capital, particularly trust and norms in family and social networks, plays a crucial role in the transmission and maintenance of intergenerational support[ 33 ]. A plethora of research has demonstrated that the capital endowments of older adults, encompassing economic, cultural, and social capital, have a significant impact on the level of trust among family members. This, in turn, has been shown to increase the degree of bottom-up intergenerational support provided by children to their parents, and vice versa[ 34 ]. The hypothesis that trust derived from capital endowments reduces transaction costs and risks has been demonstrated to facilitate efficient intergenerational transfer of resources. Furthermore, research has indicated a positive correlation between social capital and intergenerational support[ 35 ]. It has been hypothesised that individuals who possess elevated levels of social capital within their families or communities are more likely to receive enhanced intergenerational support. Moreover, it has been proposed that social capital plays a pivotal role in fostering a heightened sense of cohesion and belonging among family members, thereby furthering the facilitation of intergenerational support[ 36 ]. The intervention of social health insurance has been shown to generally enhance the capital endowment of older adults[ 37 ]. Consequently, this study proposes research hypothesis B: The impact of social health insurance quality on intergenerational health care support is influenced by differences in the socioeconomic status of older adults. Role Theory, on the other hand, explains the motivational and behavioral patterns of intergenerational support in terms of the role expectations and responsibilities of family members[ 38 ]. A number of studies have been conducted that focus on the particular manifestations of intergenerational support in immigrant families, single-parent families, and transnational families. These studies argue that cultural conflicts have the capacity to alter the patterns of intergenerational support in families by influencing the views of intergenerational support. In contrast, other studies argue that parental responsibility is closely linked to the "family-oriented" concept, and that intergenerational support is a key component of the "family-oriented" concept[ 39 ]. A number of studies have indicated a correlation between parental responsibility and the "family-oriented" concept. Furthermore, these studies have suggested that the pursuit of collective family and clan values is implicit in intergenerational support. In addition to these findings, other studies have indicated that the influence of family responsibility on intergenerational support is particularly significant in East Asian societies[ 40 ]. The content of intergenerational healthcare support is divided into three areas for discussion: intergenerational healthcare cost support, intergenerational healthcare care support, and intergenerational psychological support. The three types of support have different impacts on older adults' financial and health status, and there is a substitution effect[ 41 ], where higher levels of financial support tend to result in lower levels of caregiving support and psychological support. Consequently, the present study puts forward research hypothesis B1: High-quality social health insurance will result in the displacement of intergenerational healthcare cost support for children, with the extent of displacement demonstrating a positive correlation to their socioeconomic status. At the same time, research has shown that the "crowding-in" and "crowding-out" effects of social health insurance on intergenerational health care support are a dynamic process that is influenced by multiple factors[ 42 ]. Intergenerational healthcare support from children is 'crowded out' as social health insurance provides more specialised healthcare services to a greater number of older adults. In addition, children's socioeconomic status is positively related to the level of intergenerational support they provide to their parents. Furthermore, there is a substitution effect between the financial support provided by different socioeconomic statuses and health care support, with higher levels of financial support often leading to lower levels of health care support and psychological support. Consequently, this study puts forward research hypothesis B2: High-quality social health insurance will result in the displacement of intergenerational healthcare support for children, with the extent of displacement demonstrating a positive correlation with their socioeconomic status. The economic performance of social health insurance has been demonstrated to enhance the level of healthcare and quality of life experienced by older adults, whilst concomitantly improving intergenerational relations between said older adults and their children. This is primarily reflected in the reduction of the financial burden of medical expenditures on the elderly. The reimbursement of a proportion of medical expenses by social health insurance has been demonstrated to alleviate financial pressures on older adults, thereby encouraging the utilisation of medical care[ 43 ]. The intervention of social health insurance has been demonstrated to facilitate the financial needs of older adults in terms of healthcare to a certain extent. On the one hand, older adults are able to utilise health insurance funds to cover their own medical expenses, thereby reducing their financial reliance on their children. On the other hand, social health insurance to a certain extent mitigates the unanticipated risks faced by the older adult population, thus encouraging children to provide greater financial support, thereby enhancing the quality of medical care and overall well-being. Consequently, the level of family cohesion and intergenerational interaction is increased. Consequently, this study proposes research hypothesis C: The economic performance of high-quality social health insurance plays a mediating role in improving the level of intergenerational health care support for the older adults. The extant research suggests that the health performance of social health insurance also plays an important mediating role in improving intergenerational healthcare for older adults. Primarily, high-quality social health insurance has been demonstrated to directly enhance the health of older adults. It provides timely and effective treatment for older adults, enhancing their propensity and capacity to seek prompt medical care, preventing the deterioration of their health due to delays in treatment, and reducing their risk of poverty due to illness. Consequently, older adults' reliance on and need for medical care from their children is reduced, fostering closer intergenerational relationships due to a decrease in pressure for intergenerational support and a concomitant reduction in existing or potential intergenerational conflicts. Finally, high-quality social health insurance has been shown to have a positive impact on the mental health status of older adults. This enhanced psychological well-being has been shown to lead to a reduction in anxiety and depression, thereby improving the quality of life and overall well-being of older adults[ 44 ]. Therefore, the study constructed a mediating variable relationship model as shown in Fig. 1. Consequently, this study proposes research hypothesis D: The health performance of high-quality social health insurance plays a mediating role in improving the level of intergenerational healthcare support for older adults. Drawing upon the extant literature and theoretical assumptions, this study proposes a theoretical framework for analysing the impact of social health insurance on intergenerational healthcare support. This framework addresses the limitations of previous studies in terms of their classification of intergenerational support and explores the mechanisms through which social health insurance impacts intergenerational healthcare support. The framework of the study is shown in Fig. 1. Figure 1 Framework for analyzing. 3. Methods and results (1) Data This article has relied on the major project of philosophy and social science of the Ministry of Education, the group of 20 teachers and students as investigators. The researchers have been professionally trained and participated in the pre-survey, respectively, in July-August 2019, July-August 2021, The field questionnaire survey was conducted using a stratified sampling method in the western province of Shaanxi Province, Shaanxi Yan'an City, Baoji, Hanzhong, the central province of Hubei Province, Jingmen, Wuhan, and the eastern Ningbo City and Shaoxing City in Zhejiang Province. The target respondents were local older adults over 60 years old, and a total of 1918 questionnaires were collected, excluding missing values and invalid questionnaires. Finally, 1882 questionnaires were selected for this study. The collected questionnaire data is close to the actual situation of the older adults in the research location, and has a certain degree of representativeness. This study employs SPSS 22.0 software to assess the reliability of the questionnaire data. The results of the test can be observed in the questionnaire Cronbach α system, which is 0.925, greater than the 0.9 judgment standard. Table 1 presents the results of descriptive statistics for all variables. Table 1 Descriptive statistics of variables Variable type Variant Observed value Average value Maximum values Minimum value Implicit Variable Intergenerational Medical Cost Support 1880 2.962 5 1 Intergenerational Medical Care Support 1880 3.541 5 1 Intergenerational Psychological Support 1880 2.681 5 1 Independent Variable Social health insurance participation 1880 0.945 1 0 Satisfaction with Treatment 1880 3.661 5 1 Level of Equity 1880 3.254 5 1 Intermediary Variable Economic Improvement 1880 0.882 5 1 Health improvement 1880 0.745 5 1 Control Variable Genders 1880 0.431 1 0 Age 1880 66.2 95 60 Matrimonial 1880 0.803 1 0 Residency 1880 0.526 1 0 Household Registration 1880 0.452 1 0 Education 1880 2.205 4 1 Health 1880 2.847 5 1 (2) Variables The explanatory variable in this article is the level of intergenerational support for older adults, which the study categorises into three categories: intergenerational medical cost support, intergenerational medical care support, and intergenerational psychological support. The core explanatory variable of this article is the quality of social health insurance. A variety of indicators for measuring the quality of social health insurance currently exist in the academic community. This study employs a multifaceted approach by measuring the actual treatment and fairness dimensions, and selecting two indicators to quantify the quality level of social health insurance: satisfaction with the level of treatment and satisfaction with the fairness of treatment. The core explanatory variable of this study is the quality of medical insurance for older adults, which is divided into three dimensions: "pressure of payment burden", "degree of satisfaction with treatment level", and "degree of fairness". The rationality of such division can be explained by the New Institutional Theory. The dimension of contribution burden pressure focuses on whether the cost paid by the older adults for medical insurance is economically feasible, reflecting the economic viability of the medical insurance system. The new institutional theory emphasises that the formation and maintenance of medical insurance is contingent on its alignment with social expectations and values, including economic affordability.[45, 46] The dimension of satisfaction with treatment level involves the older adults'satisfaction with various treatment provided by medical insurance, including the reimbursement ratio of medical expenses and the quality of medical services.[47, 48] The new institutional theory points out that the legitimacy and effectiveness of institutions depend not only on whether they can meet functional needs, but also on the extent to which they can meet participants' psychological and social needs (such as satisfaction and trust).[49, 50] The equity dimension of the health insurance system is defined as the fairness and justice experienced by different age groups of older adults in relation to the distribution of resources. The equity dimension is a measurement of the fairness and justice of the health insurance system among different groups of older adults, with a focus on the equal distribution of resources. In accordance with the principles of new institutional theory, institutions are expected to promote social equity and justice, thereby ensuring that all members of society are able to access fundamental entitlements and opportunities. In addition, based on theoretical analysis, this article examines the mediating effects of social health insurance in terms of both economic performance and health performance. The economic performance is expressed in the impact on the economic situation of the older adults, which is called the "channel of improvement of the economic situation". The mediating variable was constructed based on the questionnaire question, "Are all your sources of livelihood sufficient?" The mediator variable was constructed based on the questionnaire question "Do you have enough money to live on?" and was assigned a value of 1 for the choice of "enough" and 0 for the choice of "enough" otherwise. health performance was expressed in terms of its impact on the health status of older adults, and is referred to as the "channel for improving health status". （ 3 ） results Due to the need for brevity, the study did not report the coding of all the variables. The majority of the control variables utilised were not measured using Likert scales, as evidenced in Table 1. In the case of household, for example, we employed dummy variables, assigning urban households a value of 1 and rural households a value of 0.The baseline regressions for all variables are shown in Table 2. Table 2 Benchmark regressions Variant Intergenerational Medical Cost Support Intergenerational Medical Care Support Intergenerational Psychological Support With or without social health insurance -0.225*(-1.841) 0.182 (1.258) 0.248 (1.046) Quality of social health insurance Satisfaction with Treatment -0.241*** (-3.552) 0.168*** (4.381) 0.173*** (3.625) Level of Equity -0.142*** (-2.971) 0.114** (3.086) 0.145*** (3.884) Age 0.031*** (3.265) 0.028** (2.248) 0.019*** (3.192) Genders -0.076 (-1.258) -0.325 (-1.027) -0.258 (1.149) Matrimonial -0.456*** (-3.445) -0.586** (-3.762) -0.652*** (-3.437) Residency 0.448** (3.541) 0.492*(1.974) 0.439** (1.882) Household Registration -0.421** (-2.275) -0.251** (-2.358) -0.284** (-2.524) Education -0.045*(1.836) -0.258 (-1.128) -0.263 (-1.382) Health -0.114 (-1.062) -0.247*(-1.114) -0.269 (-1.410) Note: OLS regression; ***, **, and * represent significance at the 1%, 5%, and 10% levels, respectively, and t-values are in (). As illustrated in Table 2, a negative relationship is evident between the presence or absence of social health insurance and intergenerational support for healthcare costs (-0.225*). This indicates that the existence of the social security system reduces the financial burden on families in terms of healthcare costs, underscoring the significant role of the social security system in mitigating the necessity for intra-family financial assistance. Secondly, a significant relationship is observed between satisfaction with the level of treatment and satisfaction with the fairness of treatment in the quality of social health insurance, as well as all three types of intergenerational support. This finding indicates that individual satisfaction with the social security system exerts a twofold influence on trust and reliance in the system, as well as on the support structure within the family. In addition, demographic characteristics such as age demonstrate a positive correlation with all three types of intergenerational support, suggesting that as individuals age, they may become more dependent on family support due to declining physical or social functioning. While gender does not demonstrate a significant relationship with intergenerational support, the coefficients suggest that women may provide or receive more intergenerational support than men, demonstrating that gender roles are closely related to social expectations and the intergenerational health care support they receive. Furthermore, marital status is significantly related to intergenerational support and intergenerational health care support. Marital status has been demonstrated to be significantly negatively related to intergenerational support, thus indicating the highly prevalent "self-supporting" and "mutual support" model of old age in China, where older adults are observed to rely more on their spouses than on other family members for support. Concurrently, the degree of education and the level of socioeconomic status of the older adults in terms of hukou demonstrate a negative correlation with intergenerational healthcare support in general. This finding suggests that individuals with higher socioeconomic status possess the capacity to independently manage healthcare expenditures and diminish their reliance on family support. It also signifies that urban hukou corresponds to greater social resources and support networks, which can mitigate the older adults' reliance on intergenerational support within the family. As demonstrated in Table 3, the impact of social health insurance on intergenerational medical support varies according to urban-rural differences. The analysis indicates that the quality of social health insurance exerts a significant influence on intergenerational healthcare support, with both satisfaction levels and perceptions of fairness having a substantial impact on healthcare expenditure. Specifically, in urban areas, an increase in satisfaction with treatment level and fairness has been found to result in a reduction of medical cost support by 0.585 and 0.441 units, respectively. In rural areas, this effect, while also present, is slightly less variable relative to urban areas.This suggests that the extent to which social health insurance affects intergenerational family support for healthcare costs is more pronounced in urban areas. Secondly, a significant negative effect of education level on healthcare cost support is observed in urban areas, but this effect is not significant in rural areas. This disparity may be attributed to the observation that, within urban contexts, education exhibits a stronger correlation with individual socioeconomic status, thereby facilitating access to social resources and support networks. This suggests that individuals with higher education levels tend to have access to better job opportunities, stronger awareness of insurance, health management, and greater ability to acquire and process information. The intervention of social health insurance reinforces their social support, making them more capable of self-protection in the face of healthcare expenditures, and less reliant on intergenerational family support. In contrast, rural residents demonstrate a reduced level of social support, inadequate learning abilities and autonomy, and are in a phase of learning and adapting to social health insurance, thereby indicating that the insurance does not immediately enhance their living conditions.Finally, the effect of health status on intergenerational support indirectly suggests that individuals with poorer health require greater support from their families, and the urban-rural divide persists in this regard. Social health insurance exerts a more significant impact on the intergenerational transfer of medical costs and medical care in urban areas, while in rural areas, it has a more pronounced effect on the intergenerational transfer of psychological support. The "crowding out" effect of the quality of social health insurance on intergenerational medical support is more pronounced among urban residents, which may be related to the degree of sophistication of the social health insurance system and the accessibility of services in urban areas. Table 3 Impact of social health insurance on intergenerational health care support - regression analysis by urban and rural areas Intergenerational Medical Cost Support Intergenerational Medical Care Support Intergenerational Psychological Support Quality of social health insurance municipalities countryside municipalities countryside municipalities countryside Satisfaction with Treatment -0.585** (2.218) -0.431*** (3.664) 0.425* (1.651) 0.263*** (3.528) 0.287*** (4.574) 0.365** (2.372) Level of Equity -0.441*** (3.458) -0.258* (1.771) 0.362** (2.246) 0.174** (2.159) 0.435* (1.836) 0.381* (1.762) Age 0.034*** (4.335) 0.032** (2.481) 0.035*** (3.474) 0.036*** (3.528) 0.025** (2.349) 0.028** (2.214) Genders -0.115 (-1.014) -0.142 (-1.308) -0.362 (-1.042) -0.378 (-1.774) -0.412 (-1.026) -0.478* (-0.998) Matrimonial -0.582** (-2.507) -0.446** (-2.432) -0.685* (-1.699) -0.613** (-2.083) -0.573** (-2.652) -0.682* (-1.708) Residency 0.362*** 0.447*** 0.332* 0.479*** 0.341** 0.405** Household Registration (3.662) (3.861) (1.728) (4.014) (2.367) (2.405) Education -0.038* (-1.704) -0.012 (-1.138) -0.026** (-2.465) -0.014* (-1.783) -0.042* (-1.692) -0.028 (-1.002) Health -0.128 (-1.112) -0.085 (-1.003) -0.136 (-1.264) -0.105 (-1.008) -0.125 (-1.154) -0.186 (-1.085) As illustrated in Table 4, the extant research on the impact of social health insurance on intergenerational health support has focused on the role of socioeconomic status. The quality of social health insurance exerts divergent "crowding-in" and "crowding-out" effects on older adults of differing socioeconomic status. As demonstrated in Table 4, the "crowding out" effect of higher socioeconomic status older adults in obtaining intergenerational health care cost support from their children is more pronounced. The marginal effect calculations reveal that an increase in satisfaction with treatment outcomes leads to a 31.5% and 20.7% reduction in the probability of obtaining support for intergenerational medical expenses for older adults with high and low socioeconomic status, respectively. Similarly, an increase in satisfaction with the fairness of treatment results in a 22% decrease in the probability of obtaining support for intergenerational medical expenses. 5% and 12.1% for the older adults with high and low socioeconomic status, respectively. This finding indicates that the effect of social medical insurance on the older adults with higher socioeconomic status is more pronounced than that of intergenerational support for medical expenses. This finding suggests that social health insurance functions as an additional resource for older adults with higher socio-economic status, thereby enhancing their capacity to manage health challenges. Secondly, the quality of social health insurance has a stronger "crowding-in" effect on intergenerational health care support for older adults with higher socio-economic status. The calculation of the marginal effect demonstrates that an increase in satisfaction with the level of treatment results in a 36.6% and 10.2% probability of obtaining intergenerational health care support for older adults with high and low socioeconomic status, respectively. The findings indicate that the impact of enhancing satisfaction with the fairness of treatment on the acquisition of intergenerational medical care support by older adults with low socioeconomic status is not significant. This phenomenon is not only related to the concept of "self-support" among older adults in China, but also to the high level of survival pressure faced by lower socioeconomic groups. Furthermore, the quality of social health insurance exerts a more pronounced "crowding-in" effect on the intergenerational psychosocial support from children for older adults with low socioeconomic status. The calculation of marginal effects demonstrates that an increase in satisfaction with the level of treatment results in a 12.6% and 24.7% increase in the probability of obtaining intergenerational psychological support for older adults with high and low socioeconomic status, respectively. A similar increase in satisfaction with the fairness of treatment leads to a 2.8% and 8.3% increase in the probability of obtaining intergenerational psychological support for older adults with high and low socioeconomic status, respectively. This finding suggests that older adults with lower economic status encounter heightened survival pressure but diminished risk tolerance. The findings indicate that the integration of social health insurance coverage has the potential to augment the financial reserves of this demographic, foster enhanced intra-family trust, mitigate the risk of intergenerational resource mobility, and encourage children to be more inclined to provide bottom-up intergenerational psychological support. Table 4 Impact of social health insurance on intergenerational health care support - regression analysis by economic status Intergenerational Medical Cost Support Intergenerational Medical Care Support Intergenerational Psychological Support Quality of social health insurance High socio-economic status Low socio-economic status High socio-economic status Low socio-economic status High socio-economic status Low socio-economic status Satisfaction with Treatment -0.315** (-2.382) -0.207*** (4.225) 0.366*** (4.347) 0.102** (2.138) 0.126** (1.706) 0.247** (2.034) Level of Equity -0.225*** (-3.589) -0.121** (-2.476) 0.051** (2.325) 0.018 (1.026) 0.028** (2.514) 0.083*** (3.228) Age 0.018** (2.014) 0.025*** (3.762) 0.014** (2.118) 0.035** (2.067) 0.024** (2.359) 0.087** (1.998) Genders -0.158 (-1.062) -0.065 (-1.099) -0.351 (-1.185) -0.328 (-1.259) -0.202 (-1.072) -0.242 (-1.356) Matrimonial -0.682** (-2.371) -0.523** (-2.442) -0.682 (-1.258) -0.614** (-2.483) -0.774** (-2.329) -0.685** (-2.075) Residency 0.541*** (4.027) 0.386* (1.835) 0.725** (2.051) 0.441* (1.662) 0.712* (1.728) 0.357* (1.835) Household Registration -0.251** (-2.311) -0.124** (-2.046) -0.035* (-1.785) -0.158* (-1.774) -0.028** (-2.435) -0.089* (-1.899) Education -0.047 (-1.044) -0.038* (-1.685) -0.015 (-1.056) -0.018 (-1.302) -0.026* (-1.715) -0.025 (-1.058) Health -0.258 (-0.829) -0.089 (-0.921) 0.256 (1.052) 0.122 (1.128) 0.256 (1.071) 0.122 (1.147) As illustrated in Table 5, the results of the mediating effects of economic improvement and health improvement are reported. As illustrated in Table 5, the economic performance and health performance of social health insurance mediated the enhancement in the level of intergenerational care support for older adults. In terms of improving economic status, the mediating effect of economic performance of social health insurance on intergenerational care support was found to be the most significant (β = 0.042, 95% CI [0.025-0.059]), suggesting that improving economic status contributes more indirectly to intergenerational care support. Conversely, the effect value of intergenerational psychological support was 0.037 with a 95% CI of 0.016-0.063, suggesting that improving economic status also indirectly enhances intergenerational psychological support to a certain extent. Although the effect value of intergenerational medical cost support is comparatively lower, it remains positive, signifying that enhancing economic status exerts a favourable indirect effect on intergenerational medical cost support. The findings indicate that the health status of older adults exerts a significant influence on intergenerational medical cost support, while psychological support is less impacted. This suggests that enhancing the health status of older adults can potentially augment intergenerational medical cost support and psychological support to a certain extent. For medical care support, the effect value was only 0.008 (95% CI: 0.006-0.013), suggesting that the indirect effect of improved health status on intergenerational care support is limited, but still not negligible. Consequently, the joint effect of enhanced economic status and health status on intergenerational support can be considered as indirect yet significant. The direct effects analysis yielded a -0.051 result (95% CI: -0.108 to -0.004) for the direct effect of social health insurance on intergenerational health care cost support, indicating a reduction in such costs. Conversely, for intergenerational medical care support and intergenerational psychological support, the direct effects were 0.482 and 0.282, respectively, with confidence intervals excluding zero, indicating that they directly caused an increase in care support and psychological support. Conversely, in the context of intergenerational medical cost support, the indirect effect accounted for 80.39% of the direct effect, suggesting that the indirect effect plays a predominant role in enhancing intergenerational medical cost support for older adults through social health insurance. Conversely, in the context of intergenerational care support and intergenerational psychological support, the percentage is comparatively lower, signifying that the direct effect is more pronounced in these two domains. Table 5 Analysis of mediating effects Intergenerational Medical Cost Support Intergenerational Medical Care Support Intergenerational Psychological Support Effect value (β) standard error 95% CI efficiency value standard error 95% CI efficiency value standard error 95% CI ind_eff( 1) 0.025 0.006 0.014-0.037 0.042 0.010 0.025-0.059 0.037 0.009 0.016-0.063 ind_eff( 2) 0.016 0.005 0.009-0.023 0.008 0.002 0.006-0.013 0.015 0.004 0.012-0.021 ind_eff( total) 0.041 0.008 0.028-0.043 0.047 0.011 0.018-0.073 0.022 0.008 0.015-0.028 dir_eff -0.051 0.029 -0.108-0.004 0.482 0.092 0.325-0.618 0.282 0..035 0.146-0.467 Ind_eff /dir_eff % 80.39% 9.75% 7.80% Note: ind_eff( 1) represents the indirect effect of improved economic status, ind_eff( 2) represents the indirect effect of improved health status, and ind_eff( total) represents the total indirect effect; dir_eff represents the direct effect; ind_eff /dir_eff( %) represents the indirect effect as a percentage of the direct effect; Bootstrap Sampling was set to 2000. 4. Discussion The extant empirical studies have identified a direct correlation between the quality and implementation of social health insurance, as an integral component of the social security system, and the capital endowment of older adults. This, in turn, has a consequential impact on the intergenerational health care support available to older adults. Firstly, the study identified that there are urban-rural differences in the impact of social health insurance quality on intergenerational health care support. In urban areas, the "crowding out" effect of the quality of social health insurance on intergenerational health care support is more pronounced due to a more comprehensive social health insurance system, higher accessibility of services and better prognosis. Conversely, in rural areas, the impact of social health insurance on intergenerational healthcare support is comparatively less pronounced, primarily due to the comparatively limited availability of healthcare resources and the lower popularity and quality of social health insurance services[ 51 ]. Secondly, the study revealed that there are discrepancies in the socioeconomic status of the older adults with regard to the impact of the quality of social health insurance on intergenerational health care support. Socioeconomic status is a comprehensive reflection of the capital endowment of the older adults, and the higher socioeconomic status of the older adults can satisfy their own basic medical service needs by virtue of their capital endowment. Therefore, insurance participation is not a primary factor in the decision, but rather an additional benefit. Conversely, individuals of higher socioeconomic status generally have more comprehensive social health insurance and medical protection, which serves to reduce their intergenerational reliance on their children for financial and care needs.In contrast, individuals of lower socioeconomic status have more restricted access to social health insurance and more limited access to medical costs, care services and prognostic measures, resulting in greater intergenerational dependence[ 52 ]. Thirdly, the findings indicate that the quality of social health insurance has a tendency to "crowd out" children's intergenerational support for healthcare costs, and that the degree of crowding out is positively correlated with their socioeconomic status. This suggests that social health insurance interventions do reduce children's support for their parents' healthcare costs to some extent, but that this crowding out is more pronounced among older adults who are of higher socioeconomic status[ 53 ]. The extent to which intergenerational health care support from children is diminished as social health insurance provides a greater range of specialised health care services is indicative of a 'crowding-in' effect. The "crowding-in" effect of the quality of social health insurance on intergenerational health care support from children is also stronger among older adults with higher socio-economic status, which is related to the higher awareness of insurance and health management among higher socio-economic status groups. Fourthly, the present study identifies the mediating role of the economic and health performance of social health insurance in improving the level of intergenerational medical support for older adults[ 54 ]. The findings indicate that a combination of economic and health status enhancements can indirectly encourage diverse forms of intergenerational assistance in healthcare. However, the relative significance of indirect and direct effects exhibits variation across different categories of intergenerational support. 5. Conclusions and recommendations In summary, the impact of the quality of social health insurance on intergenerational medical support for older adults is a complex and multidimensional process, influenced by a variety of factors, including urban-rural differences, the socioeconomic status of older adults and the mediating role of social health insurance. In order to enhance the quality of life and sense of well-being of older adults, it is necessary to further improve the social health insurance system, enhance the quality of services, narrow the gap between urban and rural areas, raise the level of health insurance for low-income older adults, and take into full consideration the differences in the needs of different groups in order to formulate more targeted policy measures. Firstly, the formulation of differentiated social health insurance policies for older adults of divergent socio-economic status is recommended, with the aim of enhancing the level of intergenerational medical support. Secondly, the coordination and harmonisation of social health insurance policies between urban and rural areas should be strengthened to reduce problems such as the wide disparity between urban and rural areas in terms of the impact of the quality of social health insurance on the standard of living of older adults, and the limited amelioration of intergenerational support imbalances. Finally, it is imperative to transcend the conventional economic paradigm and incorporate the long-neglected components of intergenerational medical support, namely medical care and psychological support. Declarations Data availability All the data or models that support the findings of this study are available from the corresponding author upon reasonable request. Source(s) of support/funding: This study was funded by the Major Projects of Philosophy and Social Science Research of the Ministry of Education (18JZD045).Supported by the Fundamental Research Funds for the Central Universities （2024lzujbkyqk006）. This study was funded by National Social Science Foundation of China (NSSFC) （22CRK014）. Disclosure of relationships and activities: The authors declare no conflict of interest. Ethics approval and consent to participate: Ethical approval for this study was granted by the Medical Ethics Committee of Xi'an Jiaotong University Health Sciences Center (Approval No. 2018-1200). The need for written informed consent was waived by the same ethics committee due to the anonymous and observational nature of the survey. All participants were informed about the study's purpose and the anonymity of their responses prior to their participation. Completion and return of the questionnaire were considered implied consent to participate. Acknowledgements: Thanks to the survey group of Xi’an Jiaotong University for the help in data collecting. Authors’ contributions: Zhang Chi: Conceptualization, Data curation, Formal analysis, Funding acquisition, Writing, Methodology, Project administration, Visualization; LongXuan Lin: Conceptualization, Supervision, Writing - review & editing;Xiaoyu Han: original draft, Writing, review & editing; Hengyuan Zhang: Data curation, Funding acquisition, Formal analysis; References Luo J, Cui M. For Children or Grandchildren?—The Motivation of Intergenerational Care for the Elderly in China. International Journal of Environmental Research and Public Health. 2023;20:1441. https://doi.org/10.3390/ijerph20021441. Fields NL, Anderson KA, Dabelko-Schoeny H. The Effectiveness of Adult Day Services for Older Adults: A Review of the Literature From 2000 to 2011. J Appl Gerontol. 2014;33:130–63. https://doi.org/10.1177/0733464812443308. Zhang X, Dupre ME, Qiu L, Zhou W, Zhao Y, Gu D. Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China. BMC Geriatrics. 2017;17:151. https://doi.org/10.1186/s12877-017-0538-9. Li C, Jiang S, Zhang X. Intergenerational relationship, family social support, and depression among Chinese elderly: A structural equation modeling analysis. Journal of Affective Disorders. 2019;248:73–80. https://doi.org/10.1016/j.jad.2019.01.032. Perotti E, Schwienbacher A. The political origin of pension funding. Journal of Financial Intermediation. 2009;18:384–404. https://doi.org/10.1016/j.jfi.2008.11.001. Ross CE, Mirowsky J. Does Medical Insurance Contribute to Socioeconomic Differentials in Health? The Milbank Quarterly. 2000;78:291–321. https://doi.org/10.1111/1468-0009.00171. Folbre N. Reforming Care. Politics & Society. 2008;36:373–87. https://doi.org/10.1177/0032329208320567. Arteaga O. Health Systems. In: Encyclopedia of Quality of Life and Well-Being Research. Springer, Cham; 2020. p. 1–6. https://doi.org/10.1007/978-3-319-69909-7_3390-2. Jiang H, Zhao M, Tian G, Zhao Z, Ding D, Yin M. Perceived effect of financial risk protection by the Urban–Rural Resident Basic Medical Insurance Scheme: a mixed-methods study of rural residents in China. BMJ Open. 2021;11:e047699. https://doi.org/10.1136/bmjopen-2020-047699. Ross CE, Mirowsky J. Does Medical Insurance Contribute to Socioeconomic Differentials in Health? The Milbank Quarterly. 2000;78:291–321. https://doi.org/10.1111/1468-0009.00171. Anderson M, Dobkin C, Gross T. The Effect of Health Insurance Coverage on the Use of Medical Services. American Economic Journal: Economic Policy. 2012;4:1–27. https://doi.org/10.1257/pol.4.1.1. Ehrlich I, Lui FT. Intergenerational Trade, Longevity, and Economic Growth. Journal of Political Economy. 1991;99:1029–59. https://doi.org/10.1086/261788. Ross CE, Mirowsky J. Does Medical Insurance Contribute to Socioeconomic Differentials in Health? The Milbank Quarterly. 2000;78:291–321. https://doi.org/10.1111/1468-0009.00171. Dong K. Medical insurance system evolution in China. China Economic Review. 2009;20:591–7. https://doi.org/10.1016/j.chieco.2009.05.011. Sloan FA, Zhang HH, Wang J. Upstream Intergenerational Transfers. Southern Economic Journal. 2002;69:363–80. https://doi.org/10.1002/j.2325-8012.2002.tb00497.x. Cai F, Giles J, Meng X. How well do children insure parents against low retirement income? An analysis using survey data from urban China. Journal of Public Economics. 2006;90:2229–55. https://doi.org/10.1016/j.jpubeco.2006.03.004. Yang Y, Evandrou M, Vlachantoni A. The impact of living arrangements and intergenerational support on the health status of older people in China: are rural residents disadvantaged compared to urban residents? Ageing & Society. 2023;43:469–94. https://doi.org/10.1017/S0144686X21000702. Silverstein M. Ten - Intergenerational Family Transfers in Social Context. In: Binstock RH, George LK, Cutler SJ, Hendricks J, Schulz JH, editors. Handbook of Aging and the Social Sciences (Sixth Edition). Burlington: Academic Press; 2006. p. 165–80. https://doi.org/10.1016/B978-012088388-2/50013-4. Bai Y, Bian F, Zhang L, Cao Y. The Impact of Social Support on the Health of the Rural Elderly in China. International Journal of Environmental Research and Public Health. 2020;17:2004. https://doi.org/10.3390/ijerph17062004. Cook KS, Cheshire C, Rice ERW, Nakagawa S. Social Exchange Theory. In: DeLamater J, Ward A, editors. Handbook of Social Psychology. Dordrecht: Springer Netherlands; 2013. p. 61–88. https://doi.org/10.1007/978-94-007-6772-0_3. Cropanzano R, Anthony EL, Daniels SR, Hall AV. Social Exchange Theory: A Critical Review with Theoretical Remedies. ANNALS. 2017;11:479–516. https://doi.org/10.5465/annals.2015.0099. Lawler EJ. An Affect Theory of Social Exchange. American Journal of Sociology. 2001;107:321–52. https://doi.org/10.1086/324071. Brandt M, Deindl C. Intergenerational Transfers to Adult Children in Europe: Do Social Policies Matter? Journal of Marriage and Family. 2013;75:235–51. https://doi.org/10.1111/j.1741-3737.2012.01028.x. Raut LK, Tran LH. Parental human capital investment and old-age transfers from children: Is it a loan contract or reciprocity for Indonesian families? Journal of Development Economics. 2005;77:389–414. https://doi.org/10.1016/j.jdeveco.2004.04.003. Albertini M, Kohli M, Vogel C. Intergenerational transfers of time and money in European families: common patterns — different regimes? Journal of European Social Policy. 2007;17:319–34. https://doi.org/10.1177/0958928707081068. Teerawichitchainan B, Pothisiri W, Long GT. How do living arrangements and intergenerational support matter for psychological health of elderly parents? Evidence from Myanmar, Vietnam, and Thailand. Social Science & Medicine. 2015;136–137:106–16. https://doi.org/10.1016/j.socscimed.2015.05.019. Ng ST, Tey NP, Asadullah MN. What matters for life satisfaction among the oldest-old? Evidence from China. PLOS ONE. 2017;12:e0171799. https://doi.org/10.1371/journal.pone.0171799. Wu F. Intergenerational Support and Life Satisfaction of Older Parents in China: A Rural–Urban Divide. Soc Indic Res. 2022;160:1071–98. https://doi.org/10.1007/s11205-021-02672-0. Chen F, Short SE. Household Context and Subjective Well-Being Among the Oldest Old in China. Journal of Family Issues. 2008;29:1379–403. https://doi.org/10.1177/0192513X07313602. Liu M, Zhang Q, Lu M, Kwon C-S, Quan H. Rural and Urban Disparity in Health Services Utilization in China. Medical Care. 2007;45:767. https://doi.org/10.1097/MLR.0b013e3180618b9a. Liu Y. Development of the rural health insurance system in China. Health Policy and Planning. 2004;19:159–65. https://doi.org/10.1093/heapol/czh019. Li J, Shi L, Liang H, Ding G, Xu L. Urban-rural disparities in health care utilization among Chinese adults from 1993 to 2011. BMC Health Services Research. 2018;18:102. https://doi.org/10.1186/s12913-018-2905-4. Bhandari H, Yasunobu K. What is Social Capital? A Comprehensive Review of the Concept. Asian Journal of Social Science. 2009;37:480–510. https://doi.org/10.1163/156853109X436847. Toward a Theory of Familiness: A Social Capital Perspective | Semantic Scholar. https://www.semanticscholar.org/paper/Toward-a-Theory-of-Familiness%3A-A-Social-Capital-Pearson-Carr/b804bcd828c1b684c3b7101fca107ae435d2bd81. Accessed 3 Jan 2025. de Souza EM, Grundy E. Intergenerational interaction, social capital and health: Results from a randomised controlled trial in Brazil. Social Science & Medicine. 2007;65:1397–409. https://doi.org/10.1016/j.socscimed.2007.05.022. Glass TA, Freedman M, Carlson MC, Hill J, Frick KD, Ialongo N, et al. Experience corps: Design of an intergenerational program to boost social capital and promote the health of an aging society. J Urban Health. 2004;81:94–105. https://doi.org/10.1093/jurban/jth096. Macha J, Harris B, Garshong B, Ataguba JE, Akazili J, Kuwawenaruwa A, et al. Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa. Health Policy and Planning. 2012;27 suppl_1:i46–54. https://doi.org/10.1093/heapol/czs024. Macfie J, Mcelwain NL, Houts RM, Cox MJ. Intergenerational transmission of role reversal between parent and child: Dyadic and family systems internal working models. Attachment & Human Development. 2005;7:51–65. https://doi.org/10.1080/14616730500039663. Tsai-Chae AH, Nagata DK. Asian values and perceptions of intergenerational family conflict among Asian American students. Cultural Diversity & Ethnic Minority Psychology. 2008;14:205–14. https://doi.org/10.1037/1099-9809.14.3.205. Silverstein M, Conroy SJ, Gans D. Beyond solidarity, reciprocity and altruism: moral capital as a unifying concept in intergenerational support for older people. Ageing & Society. 2012;32:1246–62. https://doi.org/10.1017/S0144686X1200058X. Silverstein M, Gans D, Yang FM. Intergenerational Support to Aging Parents: The Role of Norms and Needs. Journal of Family Issues. 2006;27:1068–84. https://doi.org/10.1177/0192513X06288120. Strupat C, Klohn F. Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana. World Development. 2018;104:212–21. https://doi.org/10.1016/j.worlddev.2017.11.004. Dekker M, Wilms A. Health Insurance and Other Risk-Coping Strategies in Uganda: The Case of Microcare Insurance Ltd. World Development. 2010;38:369–78. https://doi.org/10.1016/j.worlddev.2009.09.004. Murayama Y, Ohba H, Yasunaga M, Nonaka K, Takeuchi R, Nishi M, et al. The effect of intergenerational programs on the mental health of elderly adults. Aging & Mental Health. 2015. Teixeira M, Martins MIC, Lamarca ICSA, Oliveira S. ABORDAGENS DO TRABALHO NO SETOR PÚBLICO DE SAÚDE: UMA REVISÃO NARRATIVA DA LITERATURA. Trab educ saúde. 2020;18 suppl 1:e0025688. https://doi.org/10.1590/1981-7746-sol00256. Chita State Medical Academy, Khodakova OV, Koshevaya NV, Chita State Medical Academy. INFORMATION SUPPORT OF THE INSURED CITIZENS AS INFLUENCING DISPENSERIZATION EFFICIENCY FACTOR. SMR. 2018;:84–91. https://doi.org/10.20333/2500136-2018-6-84-91. Fang J, Liu L, Fang P. What is the most important factor affecting patient satisfaction – a study based on gamma coefficient. PPA. 2019;Volume 13:515–25. https://doi.org/10.2147/PPA.S197015. Liu L, Fang J. Study On Potential Factors Of Patient Satisfaction: Based On Exploratory Factor Analysis. PPA. 2019;Volume 13:1983–94. https://doi.org/10.2147/PPA.S228073. Nee V. 3. The New Institutionalisms in Economics and Sociology. In: Smelser NJ, Swedberg R, editors. The Handbook of Economic Sociology. Princeton University Press; 2010. p. 49–74. https://doi.org/10.1515/9781400835584.49. Gjølberg M. Explaining Regulatory Preferences: CSR, Soft Law, or Hard Law? Insights from a Survey of Nordic Pioneers in CSR. Bus polit. 2011;13:1–31. https://doi.org/10.2202/1469-3569.1351. Tang S, Yang T, Ye C, Liu M, Gong Y, Yao L, et al. Research on grandchild care and depression of chinese older adults based on CHARLS2018: the mediating role of intergenerational support from children. BMC Public Health. 2022;22:137. https://doi.org/10.1186/s12889-022-12553-x. Liu H, Li S, Feldman MW. Gender in Marriage and Life Satisfaction Under Gender Imbalance in China: The Role of Intergenerational Support and SES. Soc Indic Res. 2013;114:915–33. https://doi.org/10.1007/s11205-012-0180-z. Skropeta CM, Colvin A, Sladen S. An evaluative study of the benefits of participating in intergenerational playgroups in aged care for older people. BMC Geriatr. 2014;14:109. https://doi.org/10.1186/1471-2318-14-109. Guo M, Chi I, Silverstein M. Intergenerational support and depression among Chinese older adults: do gender and widowhood make a difference? Ageing and Society. 2017;37:695–724. https://doi.org/10.1017/S0144686X15001403. Additional Declarations No competing interests reported. Supplementary Files questionnaire.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 11 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviewers invited by journal 09 Oct, 2025 Editor assigned by journal 06 Oct, 2025 Editor invited by journal 17 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 16 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7600300","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":531848735,"identity":"42d46a5f-3a65-49ba-bd3f-ccf9c7ef259f","order_by":0,"name":"Chi Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIie3PMQuCQBTA8TsOdDlwfaLhVxAECxz6KrrkIo3R4HAg6Nga1OdoFg5usr2hxcW5IMIpUqH10i3o/sPjDe83PIRUql8MhllSQx8WMoGY2VSCXD6WOIesqR/p1fa43gDaBhHTz6WU4KOYe7ZoqM/RClAVR4yuQykhEPqWyXhPBOCcRwyoKyUaxM+BeBnOAb9GEAqJb9474hKiAWYjCECysZDgFLhGFqGIvZwmcuLs45PZpnxpFEV9uaXBbKdXctJH6GcL++++3nfhdsyVSqVS/W9v8f89bWiR+XwAAAAASUVORK5CYII=","orcid":"","institution":"Lanzhou University","correspondingAuthor":true,"prefix":"","firstName":"Chi","middleName":"","lastName":"Zhang","suffix":""},{"id":531848736,"identity":"59ec90ee-3598-47c6-b7a1-3614b01913ff","order_by":1,"name":"Longxuan Lin","email":"","orcid":"","institution":"Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Longxuan","middleName":"","lastName":"Lin","suffix":""},{"id":531848737,"identity":"c57dcc2b-3528-4a67-9398-b27b5741098c","order_by":2,"name":"Xiaoyu Han","email":"","orcid":"","institution":"Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyu","middleName":"","lastName":"Han","suffix":""},{"id":531848738,"identity":"3497f613-99ea-4f19-9fe8-6e434f58b68e","order_by":3,"name":"Hengyuan Zhang","email":"","orcid":"","institution":"Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Hengyuan","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-09-12 12:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7600300/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7600300/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94171448,"identity":"43fad13c-ca35-49ee-9b12-a4d581b8980c","added_by":"auto","created_at":"2025-10-23 07:34:43","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":149277,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptMainFileanonymous1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/623f6f4d96b7c98f8787931a.docx"},{"id":94172689,"identity":"195886a8-4c23-4b21-8d82-0aa4cb6ba542","added_by":"auto","created_at":"2025-10-23 07:42:43","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6732,"visible":true,"origin":"","legend":"","description":"","filename":"1a02751062e8473091b9a1c028292eaa.json","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/8572a72d3c2b15ad4a14bd20.json"},{"id":94171451,"identity":"0298af49-a5c1-4fa8-8fda-26f4f673d44e","added_by":"auto","created_at":"2025-10-23 07:34:43","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60234,"visible":true,"origin":"","legend":"","description":"","filename":"questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/e136cc93fe3481eef7298f68.docx"},{"id":94171453,"identity":"43c24cc8-40d7-4090-8fb6-47935c96bb21","added_by":"auto","created_at":"2025-10-23 07:34:43","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":166039,"visible":true,"origin":"","legend":"","description":"","filename":"1a02751062e8473091b9a1c028292eaa1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/cd4dcd6c6025964b067ea2af.xml"},{"id":94172690,"identity":"508419f2-a651-4a2e-88d3-1d622c5aa1c7","added_by":"auto","created_at":"2025-10-23 07:42:43","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":56932,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/2246d65c856defe38bf0a2e0.jpeg"},{"id":94171449,"identity":"984d363c-7b97-46cf-8e80-086a771aed87","added_by":"auto","created_at":"2025-10-23 07:34:43","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11920,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/7297d015717ad841d835aa1f.png"},{"id":94171455,"identity":"884de29e-3d75-4f48-887a-23081ebe3c3d","added_by":"auto","created_at":"2025-10-23 07:34:43","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":162401,"visible":true,"origin":"","legend":"","description":"","filename":"1a02751062e8473091b9a1c028292eaa1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/1b85d2de3f1ebdb11fa15c05.xml"},{"id":94172691,"identity":"2b84f8af-4afa-41a0-bd2f-5c0afcd4c3c9","added_by":"auto","created_at":"2025-10-23 07:42:43","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":175789,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/d6fbabf4c5798d641ebc4e51.html"},{"id":94171446,"identity":"fd6f4315-708b-4501-a64b-d5776b99ad4a","added_by":"auto","created_at":"2025-10-23 07:34:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":100461,"visible":true,"origin":"","legend":"\u003cp\u003eFramework for analyzing.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/f8979156c7e93abc290df7bc.png"},{"id":94172919,"identity":"10b7b6b0-9f64-44cd-b749-b57f71ff1325","added_by":"auto","created_at":"2025-10-23 07:50:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1586756,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/a9f1274c-d95f-4707-8466-1b71c2a4a6fb.pdf"},{"id":94171447,"identity":"8425c613-72de-4091-a5a4-2f237fe2a799","added_by":"auto","created_at":"2025-10-23 07:34:43","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":60234,"visible":true,"origin":"","legend":"","description":"","filename":"questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7600300/v1/fa1c6b65013fb1825618f6ce.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Social Health Insurance Quality on Intergenerational Medical Support for Older Adults","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAs the global population experiences an increase in the proportion of older people and a shift in family structures, the intergenerational support needs of older groups are increasing. This is in conflict with the employment pressures induced by the uneven economic development of young people. This has created an intergenerational support problem that needs to be resolved urgently[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the People's Republic of China, this problem is especially acute. The 2022 National Bulletin on the Development of the Aging Career reveals that by the end of 2022, the country had a total of 209.78\u0026nbsp;million older adults aged 65 and above, constituting 14.9% of the total population and exhibiting a dependency ratio of 21.8%. The Guiding Opinions on Promoting the Integration of Healthcare and Older Adults Care advocate the provision of integrated healthcare and older adults care services, with the aim of accelerating the integration of healthcare with the social and medical support required by older adults, thereby addressing the need for such support[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFollowing the implementation of reforms and the introduction of market-driven economic policies, China has witnessed a consistent enhancement in the scope and quality of its social health insurance coverage[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recent studies have demonstrated significant advancements in the social support systems available to older adults in China, when compared with previous decades. However, research findings also indicate the presence of a robust intergenerational solidarity within Chinese society. Adult children's provision of intergenerational support to their parents remains the most significant resource for older adults in China, while intergenerational medical support has emerged as the most substantial component of the social and medical support framework available to this demographic[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e"},{"header":"2. Literature Review and Theoretical Foundations","content":"\u003cp\u003e\u003cb\u003e(1) Social health insurance\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSocial health insurance constitutes a pivotal component of the social security system. Its fundamental objective is to furnish financial protection to the insured in the event of medical expenses, utilising the mechanism of pooled risk sharing[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As fundraising groups grew, this form evolved into a more stable and widespread social health insurance system[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As the 19th century drew to a close, the advent of private insurance in Western Europe rendered social health insurance a pivotal means by which the state could finance healthcare[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Today, it has evolved into two categories: commercial insurance and universal social health insurance[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], The present study concentrates on the branch of universal social health insurance, and all subsequent references to social health insurance pertain to policy-based, universal social health insurance.\u003c/p\u003e\u003cp\u003eUniversal social medical insurance constitutes a social medical security system that provides extensive coverage and guarantees fairness for all individuals. Its principal feature is to ensure that all people have access to basic health services, especially vulnerable and low-income groups, through a uniform system design. The most typical inclusive social medical insurance in China is the medical insurance for urban and rural residents, and individuals can be guaranteed as long as they pay relatively low(lower than other forms of insurance, such as employment-based or private insurance[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]) medical insurance fees. The financing of this system is predominantly public, stemming from the socialist commitment to ensuring medical fairness, thus justifying its categorization as a form of social medical insurance.\u003c/p\u003e\u003cp\u003eSocial health insurance fulfils a dual role within the economic system, functioning as both a financial instrument and a social security mechanism. This duality is underpinned by the principles of fairness and justice, which serve as fundamental values within the societal context[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The social health insurance system has been demonstrated to exert a favourable influence on the healthcare service market. This influence is characterised by an augmentation in demand for healthcare services, which in turn serves to promote an equilibrium between supply and demand within the healthcare sector[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe multifaceted nature of social medical insurance, encompassing entities such as insurance companies, organisations, policyholders and medical institutions, gives rise to a sophisticated insurance ecosystem. The intricacies of this ecosystem, including its interactive components, the dynamics of supply and demand, risk management and associated concerns, constitute pivotal subjects for academic inquiry[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe number of individuals enrolled in China's social medical insurance scheme is increasing, yet disparities in healthcare access persist, particularly in rural regions. This phenomenon underscores the existing socio-economic and geographical disparities between urban and rural communities[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, the efficient functioning of the social health insurance system is contingent upon an adequate fund balance. However, the issue of fund imbalance is pervasive throughout the country[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe present study focuses specifically on social health insurance rather than commercial insurance for several reasons. First, in China, social health insurance\u0026mdash;such as Urban Employee Basic Medical Insurance and Urban and Rural Resident Basic Medical Insurance\u0026mdash;is the predominant form of medical coverage for the older population, with near-universal enrollment among older adults. In contrast, commercial insurance plays a supplementary role and remains underutilized, especially among low-income and rural elderly populations. Second, social health insurance is state-regulated and collectively financed, reflecting broader institutional and redistributive mechanisms that influence intergenerational support patterns. Third, social health insurance is subject to policy reforms and quality variations across regions, making it a more suitable focus for examining policy-driven disparities in intergenerational healthcare support. Therefore, this study concentrates on the quality dimensions of social health insurance\u0026mdash;namely treatment satisfaction and equity perception\u0026mdash;to evaluate its nuanced role in shaping family-based support structures among older adults.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2) Intergenerational support\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIntergenerational support can be defined as the transfer of material and spiritual resources between older adults aged 60 and over and their adult children. The concept has its origins in family studies and gerontological research, and has gained prominence with the accelerating global aging process and changes in family structure. The practice of mutual support, encompassing financial, emotional, and practical assistance, occurs across generations within a family unit or a more expansive social network[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Not only does it enhance individuals' social connections and improve quality of life and psychological well-being at the individual level[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], but it also serves to maintain family relationships, enhance family cohesion, and provide stress resilience support at the family level[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], At the societal level, intergenerational support also plays a significant role. From a social perspective, it is evident that intergenerational support fosters the rational allocation and utilisation of community resources, thereby enhancing community cohesion and stability[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial exchange theory posits that intergenerational support is predicated on the principles of reciprocity and exchange. The theory is predicated on the premise that all human behaviour is driven by some form of reward or punishment[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In the context of intergenerational relationships, the concept of rewards and punishments is manifested through the dynamics of mutual support and reciprocity among family members. The principle of reciprocity governs the expectation that each generation will receive some form of reward from the other, which can manifest in material or spiritual forms[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. From this standpoint, intergenerational support can be regarded as a form of investment. The assistance that parents provide to their offspring during the parenting process can be conceptualised as a \"capital investment\" in their children. This investment accrues a return as the children mature and the parents grow older[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Social health insurance has been demonstrated to play a role in coordinating public and private intergenerational wealth flows, facilitating the alignment of social support with intergenerational support, especially intergenerational health support, to enhance the quality of life and well-being of older adults.\u003c/p\u003e\u003cp\u003eThe bi-directional nature of intergenerational support is particularly pronounced in Chinese society. In contrast to the Western \"relay\" model of unidirectional, cyclical intergenerational support, Chinese intergenerational support relationships are a \"feedback\" model of bi-directional obligations[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It has been posited that within East Asian societies, where filial piety predominates, parents' intergenerational support is significantly more pronounced than that received from their children, owing to a confluence of factors including family transmission, emotional values, and cultural traditions such as the \"joy of family\", \"social face\", \"social responsibility\", and the \"joy of family\"[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The considerations of \"social face\", \"child-rearing for old age\", and \"succession\" can be viewed as a reciprocal exchange of economic and psychological comfort values[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The increased involvement of social health insurance has been demonstrated to have a number of notable consequences. Firstly, it has been shown to increase the level of social support for older adults. Secondly, it has been demonstrated to improve the economic and health status of older adults. Thirdly, it has been demonstrated to increase the likelihood that parents will return intergenerational support to their children, especially intergenerational medical support. Finally, it has been demonstrated to similarly strengthen the intergenerational support provided by children to their parents[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Specifically, social health insurance interventions have different impacts on the financial support, medical care support, and psychological support provided by children[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and the specific utility of social health insurance is also closely related to the older person's own situation[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In the context of China's real-world circumstances, there is a divergence between the actual outcomes of the implementation of social health insurance policies and the idealised model. Furthermore, there are evident disparities in the effectiveness of these policies between urban and rural regions[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Nonetheless, there are certain institutional deficiencies in the process of promoting the popularisation of social health insurance. Furthermore, there are urban-rural differences in the impact of social health insurance on the financial support provided by children to their parents[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The amount that is paid back to people with insurance is very different in urban areas. This means that the amount of help that people with insurance get from their families is not getting better. In rural areas, most of the people who are attracted to the scheme have lower to middle incomes, poorer health and are more likely to have insurance programmes with shorter payback periods, which makes it difficult to achieve a positive cycle of long-term health improvement for the insured[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In addition, in the medical process, the level of prognosis that the medical process can provide varies due to the level of medical facilities and services in urban and rural areas[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], so there is a problem of the quality of urban and rural social health insurance has a large difference in the impact of the standard of living of the older adults, and the limited role of intergenerational support imbalance produced by the improvement of the role of the older adults .\u003c/p\u003e\u003cp\u003e\u003cb\u003e Based on this, this study proposes research hypothesis A: There is an urban-rural difference in the effect of social health insurance quality on intergenerational health care support.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn addition, social capital theory posits that social capital, particularly trust and norms in family and social networks, plays a crucial role in the transmission and maintenance of intergenerational support[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. A plethora of research has demonstrated that the capital endowments of older adults, encompassing economic, cultural, and social capital, have a significant impact on the level of trust among family members. This, in turn, has been shown to increase the degree of bottom-up intergenerational support provided by children to their parents, and vice versa[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The hypothesis that trust derived from capital endowments reduces transaction costs and risks has been demonstrated to facilitate efficient intergenerational transfer of resources. Furthermore, research has indicated a positive correlation between social capital and intergenerational support[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. It has been hypothesised that individuals who possess elevated levels of social capital within their families or communities are more likely to receive enhanced intergenerational support. Moreover, it has been proposed that social capital plays a pivotal role in fostering a heightened sense of cohesion and belonging among family members, thereby furthering the facilitation of intergenerational support[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The intervention of social health insurance has been shown to generally enhance the capital endowment of older adults[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eConsequently, this study proposes research hypothesis B: The impact of social health insurance quality on intergenerational health care support is influenced by differences in the socioeconomic status of older adults.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRole Theory, on the other hand, explains the motivational and behavioral patterns of intergenerational support in terms of the role expectations and responsibilities of family members[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A number of studies have been conducted that focus on the particular manifestations of intergenerational support in immigrant families, single-parent families, and transnational families. These studies argue that cultural conflicts have the capacity to alter the patterns of intergenerational support in families by influencing the views of intergenerational support. In contrast, other studies argue that parental responsibility is closely linked to the \"family-oriented\" concept, and that intergenerational support is a key component of the \"family-oriented\" concept[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A number of studies have indicated a correlation between parental responsibility and the \"family-oriented\" concept. Furthermore, these studies have suggested that the pursuit of collective family and clan values is implicit in intergenerational support. In addition to these findings, other studies have indicated that the influence of family responsibility on intergenerational support is particularly significant in East Asian societies[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e The content of intergenerational healthcare support is divided into three areas for discussion: intergenerational healthcare cost support, intergenerational healthcare care support, and intergenerational psychological support. The three types of support have different impacts on older adults' financial and health status, and there is a substitution effect[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], where higher levels of financial support tend to result in lower levels of caregiving support and psychological support.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConsequently, the present study puts forward research hypothesis B1: High-quality social health insurance will result in the displacement of intergenerational healthcare cost support for children, with the extent of displacement demonstrating a positive correlation to their socioeconomic status.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt the same time, research has shown that the \"crowding-in\" and \"crowding-out\" effects of social health insurance on intergenerational health care support are a dynamic process that is influenced by multiple factors[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Intergenerational healthcare support from children is 'crowded out' as social health insurance provides more specialised healthcare services to a greater number of older adults. In addition, children's socioeconomic status is positively related to the level of intergenerational support they provide to their parents. Furthermore, there is a substitution effect between the financial support provided by different socioeconomic statuses and health care support, with higher levels of financial support often leading to lower levels of health care support and psychological support.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConsequently, this study puts forward research hypothesis B2: High-quality social health insurance will result in the displacement of intergenerational healthcare support for children, with the extent of displacement demonstrating a positive correlation with their socioeconomic status.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe economic performance of social health insurance has been demonstrated to enhance the level of healthcare and quality of life experienced by older adults, whilst concomitantly improving intergenerational relations between said older adults and their children. This is primarily reflected in the reduction of the financial burden of medical expenditures on the elderly. The reimbursement of a proportion of medical expenses by social health insurance has been demonstrated to alleviate financial pressures on older adults, thereby encouraging the utilisation of medical care[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The intervention of social health insurance has been demonstrated to facilitate the financial needs of older adults in terms of healthcare to a certain extent. On the one hand, older adults are able to utilise health insurance funds to cover their own medical expenses, thereby reducing their financial reliance on their children. On the other hand, social health insurance to a certain extent mitigates the unanticipated risks faced by the older adult population, thus encouraging children to provide greater financial support, thereby enhancing the quality of medical care and overall well-being. Consequently, the level of family cohesion and intergenerational interaction is increased.\u003c/p\u003e\u003cp\u003e\u003cb\u003e Consequently, this study proposes research hypothesis C: The economic performance of high-quality social health insurance plays a mediating role in improving the level of intergenerational health care support for the older adults.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe extant research suggests that the health performance of social health insurance also plays an important mediating role in improving intergenerational healthcare for older adults. Primarily, high-quality social health insurance has been demonstrated to directly enhance the health of older adults. It provides timely and effective treatment for older adults, enhancing their propensity and capacity to seek prompt medical care, preventing the deterioration of their health due to delays in treatment, and reducing their risk of poverty due to illness. Consequently, older adults' reliance on and need for medical care from their children is reduced, fostering closer intergenerational relationships due to a decrease in pressure for intergenerational support and a concomitant reduction in existing or potential intergenerational conflicts. Finally, high-quality social health insurance has been shown to have a positive impact on the mental health status of older adults. This enhanced psychological well-being has been shown to lead to a reduction in anxiety and depression, thereby improving the quality of life and overall well-being of older adults[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Therefore, the study constructed a mediating variable relationship model as shown in Fig.\u0026nbsp;1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConsequently, this study proposes research hypothesis D: The health performance of high-quality social health insurance plays a mediating role in improving the level of intergenerational healthcare support for older adults.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eDrawing upon the extant literature and theoretical assumptions, this study proposes a theoretical framework for analysing the impact of social health insurance on intergenerational healthcare support. This framework addresses the limitations of previous studies in terms of their classification of intergenerational support and explores the mechanisms through which social health insurance impacts intergenerational healthcare support. The framework of the study is shown in Fig.\u0026nbsp;1.\u003c/p\u003e\u003cp\u003eFigure 1 Framework for analyzing.\u003c/p\u003e"},{"header":"3. Methods and results","content":"\u003cp\u003e\u003cstrong\u003e(1) Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article has relied on the major project of philosophy and social science of the Ministry of Education, the group of 20 teachers and students as investigators. The researchers have been professionally trained and participated in the pre-survey, respectively, in July-August 2019, July-August 2021, The field questionnaire survey was conducted using a stratified sampling method in the western province of Shaanxi Province, Shaanxi Yan\u0026apos;an City, Baoji, Hanzhong, the central province of Hubei Province, Jingmen, Wuhan, and the eastern Ningbo City and Shaoxing City in Zhejiang Province. The target respondents were local older adults over 60 years old, and a total of 1918 questionnaires were collected, excluding missing values and invalid questionnaires. Finally, 1882 questionnaires were selected for this study. The collected questionnaire data is close to the actual situation of the older adults in the research location, and has a certain degree of representativeness. This study employs SPSS 22.0 software to assess the reliability of the questionnaire data. The results of the test can be observed in the questionnaire Cronbach\u0026nbsp;\u0026alpha;\u0026nbsp;system, which is 0.925, greater than the 0.9 judgment standard. Table 1 presents the results of descriptive statistics for all variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Descriptive statistics of variables\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eVariable type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eVariant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eObserved value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eAverage value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eMaximum values\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eMinimum value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eImplicit Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eIntergenerational Medical Cost Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2.962\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eIntergenerational Medical Care Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eIntergenerational Psychological Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eIndependent Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eSocial health insurance participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eSatisfaction with Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eLevel of Equity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eIntermediary Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eEconomic Improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eHealth improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eControl Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eGenders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e66.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eMatrimonial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eHousehold Registration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eHealth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2.847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e(2) Variables\u003c/p\u003e\n\u003cp\u003eThe explanatory variable in this article is the level of intergenerational support for older adults, which the study categorises into three categories: intergenerational medical cost support, intergenerational medical care support, and intergenerational psychological support. The core explanatory variable of this article is the quality of social health insurance. A variety of indicators for measuring the quality of social health insurance currently exist in the academic community. This study employs a multifaceted approach by measuring the actual treatment and fairness dimensions, and selecting two indicators to quantify the quality level of social health insurance: satisfaction with the level of treatment and satisfaction with the fairness of treatment.\u003c/p\u003e\n\u003cp\u003eThe core explanatory variable of this study is the quality of medical insurance for older adults, which is divided into three dimensions: \u0026quot;pressure of payment burden\u0026quot;, \u0026quot;degree of satisfaction with treatment level\u0026quot;, and \u0026quot;degree of fairness\u0026quot;. The rationality of such division can be explained by the New Institutional Theory. The dimension of contribution burden pressure focuses on whether the cost paid by the older adults for medical insurance is economically feasible, reflecting the economic viability of the medical insurance system. The new institutional theory emphasises that the formation and maintenance of medical insurance is contingent on its alignment with social expectations and values, including economic affordability.[45, 46] The dimension of satisfaction with treatment level involves the older adults\u0026apos;satisfaction with various treatment provided by medical insurance, including the reimbursement ratio of medical expenses and the quality of medical services.[47, 48] The new institutional theory points out that the legitimacy and effectiveness of institutions depend not only on whether they can meet functional needs, but also on the extent to which they can meet participants\u0026apos; psychological and social needs (such as satisfaction and trust).[49, 50] The equity dimension of the health insurance system is defined as the fairness and justice experienced by different age groups of older adults in relation to the distribution of resources. The equity dimension is a measurement of the fairness and justice of the health insurance system among different groups of older adults, with a focus on the equal distribution of resources. In accordance with the principles of new institutional theory, institutions are expected to promote social equity and justice, thereby ensuring that all members of society are able to access fundamental entitlements and opportunities.\u003c/p\u003e\n\u003cp\u003eIn addition, based on theoretical analysis, this article examines the mediating effects of social health insurance in terms of both economic performance and health performance. The economic performance is expressed in the impact on the economic situation of the older adults, which is called the \u0026quot;channel of improvement of the economic situation\u0026quot;. The mediating variable was constructed based on the questionnaire question, \u0026quot;Are all your sources of livelihood sufficient?\u0026quot; The mediator variable was constructed based on the questionnaire question \u0026quot;Do you have enough money to live on?\u0026quot; and was assigned a value of 1 for the choice of \u0026quot;enough\u0026quot; and 0 for the choice of \u0026quot;enough\u0026quot; otherwise. health performance was expressed in terms of its impact on the health status of older adults, and is referred to as the \u0026quot;channel for improving health status\u0026quot;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003eresults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the need for brevity, the study did not report the coding of all the variables. The majority of the control variables utilised were not measured using Likert scales, as evidenced in Table 1. In the case of household, for example, we employed dummy variables, assigning urban households a value of 1 and rural households a value of 0.The baseline regressions for all variables are shown in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Benchmark regressions\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eVariant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eIntergenerational Medical Cost Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eIntergenerational Medical Care Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eIntergenerational Psychological Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eWith or without social health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-0.225*(-1.841)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.182 (1.258)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.248 (1.046)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eQuality of social health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eSatisfaction with Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-0.241*** (-3.552)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.168*** (4.381)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.173*** (3.625)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eLevel of Equity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-0.142*** (-2.971)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.114** (3.086)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.145*** (3.884)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.031*** (3.265)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.028** (2.248)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.019*** (3.192)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eGenders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-0.076 (-1.258)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.325 (-1.027)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.258 (1.149)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eMatrimonial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-0.456*** (-3.445)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.586** (-3.762)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.652*** (-3.437)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.448** (3.541)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.492*(1.974)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.439** (1.882)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eHousehold Registration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-0.421** (-2.275)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.251** (-2.358)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.284** (-2.524)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-0.045*(1.836)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.258 (-1.128)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.263 (-1.382)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eHealth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-0.114 (-1.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.247*(-1.114)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.269 (-1.410)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: OLS regression; ***, **, and * represent significance at the 1%, 5%, and 10% levels, respectively, and t-values are in ().\u003c/p\u003e\n\u003cp\u003eAs illustrated in Table 2, a negative relationship is evident between the presence or absence of social health insurance and intergenerational support for healthcare costs (-0.225*). This indicates that the existence of the social security system reduces the financial burden on families in terms of healthcare costs, underscoring the significant role of the social security system in mitigating the necessity for intra-family financial assistance. Secondly, a significant relationship is observed between satisfaction with the level of treatment and satisfaction with the fairness of treatment in the quality of social health insurance, as well as all three types of intergenerational support. This finding indicates that individual satisfaction with the social security system exerts a twofold influence on trust and reliance in the system, as well as on the support structure within the family. In addition, demographic characteristics such as age demonstrate a positive correlation with all three types of intergenerational support, suggesting that as individuals age, they may become more dependent on family support due to declining physical or social functioning. While gender does not demonstrate a significant relationship with intergenerational support, the coefficients suggest that women may provide or receive more intergenerational support than men, demonstrating that gender roles are closely related to social expectations and the intergenerational health care support they receive. Furthermore, marital status is significantly related to intergenerational support and intergenerational health care support. Marital status has been demonstrated to be significantly negatively related to intergenerational support, thus indicating the highly prevalent \u0026quot;self-supporting\u0026quot; and \u0026quot;mutual support\u0026quot; model of old age in China, where older adults are observed to rely more on their spouses than on other family members for support. Concurrently, the degree of education and the level of socioeconomic status of the older adults in terms of hukou demonstrate a negative correlation with intergenerational healthcare support in general. This finding suggests that individuals with higher socioeconomic status possess the capacity to independently manage healthcare expenditures and diminish their reliance on family support. It also signifies that urban hukou corresponds to greater social resources and support networks, which can mitigate the older adults\u0026apos; reliance on intergenerational support within the family.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs demonstrated in Table 3, the impact of social health insurance on intergenerational medical support varies according to urban-rural differences. The analysis indicates that the quality of social health insurance exerts a significant influence on intergenerational healthcare support, with both satisfaction levels and perceptions of fairness having a substantial impact on healthcare expenditure. Specifically, in urban areas, an increase in satisfaction with treatment level and fairness has been found to result in a reduction of medical cost support by 0.585 and 0.441 units, respectively. In rural areas, this effect, while also present, is slightly less variable relative to urban areas.This suggests that the extent to which social health insurance affects intergenerational family support for healthcare costs is more pronounced in urban areas. Secondly, a significant negative effect of education level on healthcare cost support is observed in urban areas, but this effect is not significant in rural areas. This disparity may be attributed to the observation that, within urban contexts, education exhibits a stronger correlation with individual socioeconomic status, thereby facilitating access to social resources and support networks. This suggests that individuals with higher education levels tend to have access to better job opportunities, stronger awareness of insurance, health management, and greater ability to acquire and process information. The intervention of social health insurance reinforces their social support, making them more capable of self-protection in the face of healthcare expenditures, and less reliant on intergenerational family support. In contrast, rural residents demonstrate a reduced level of social support, inadequate learning abilities and autonomy, and are in a phase of learning and adapting to social health insurance, thereby indicating that the insurance does not immediately enhance their living conditions.Finally, the effect of health status on intergenerational support indirectly suggests that individuals with poorer health require greater support from their families, and the urban-rural divide persists in this regard. Social health insurance exerts a more significant impact on the intergenerational transfer of medical costs and medical care in urban areas, while in rural areas, it has a more pronounced effect on the intergenerational transfer of psychological support. The \u0026quot;crowding out\u0026quot; effect of the quality of social health insurance on intergenerational medical support is more pronounced among urban residents, which may be related to the degree of sophistication of the social health insurance system and the accessibility of services in urban areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Impact of social health insurance on intergenerational health care support - regression analysis by urban and rural areas\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"120%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eIntergenerational Medical Cost Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eIntergenerational Medical Care Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eIntergenerational Psychological Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eQuality of social health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003emunicipalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ecountryside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003emunicipalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ecountryside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003emunicipalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ecountryside\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eSatisfaction with Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.585**\u003c/p\u003e\n \u003cp\u003e(2.218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.431***\u003c/p\u003e\n \u003cp\u003e(3.664)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.425*\u003c/p\u003e\n \u003cp\u003e(1.651)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.263***\u003c/p\u003e\n \u003cp\u003e(3.528)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.287***\u003c/p\u003e\n \u003cp\u003e(4.574)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.365**\u003c/p\u003e\n \u003cp\u003e(2.372)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eLevel of Equity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.441***\u003c/p\u003e\n \u003cp\u003e(3.458)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.258*\u003c/p\u003e\n \u003cp\u003e(1.771)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.362**\u003c/p\u003e\n \u003cp\u003e(2.246)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.174**\u003c/p\u003e\n \u003cp\u003e(2.159)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.435*\u003c/p\u003e\n \u003cp\u003e(1.836)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.381*\u003c/p\u003e\n \u003cp\u003e(1.762)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.034***\u003c/p\u003e\n \u003cp\u003e(4.335)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.032**\u003c/p\u003e\n \u003cp\u003e(2.481)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.035***\u003c/p\u003e\n \u003cp\u003e(3.474)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.036***\u003c/p\u003e\n \u003cp\u003e(3.528)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.025**\u003c/p\u003e\n \u003cp\u003e(2.349)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.028**\u003c/p\u003e\n \u003cp\u003e(2.214)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eGenders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.115\u003c/p\u003e\n \u003cp\u003e(-1.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.142\u003c/p\u003e\n \u003cp\u003e(-1.308)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.362\u003c/p\u003e\n \u003cp\u003e(-1.042)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.378\u003c/p\u003e\n \u003cp\u003e(-1.774)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.412\u003c/p\u003e\n \u003cp\u003e(-1.026)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.478*\u003c/p\u003e\n \u003cp\u003e(-0.998)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eMatrimonial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.582**\u003c/p\u003e\n \u003cp\u003e(-2.507)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.446**\u003c/p\u003e\n \u003cp\u003e(-2.432)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.685*\u003c/p\u003e\n \u003cp\u003e(-1.699)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.613**\u003c/p\u003e\n \u003cp\u003e(-2.083)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.573**\u003c/p\u003e\n \u003cp\u003e(-2.652)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.682*\u003c/p\u003e\n \u003cp\u003e(-1.708)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.362***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.447***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.332*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.479***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.341**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.405**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eHousehold Registration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e(3.662)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e(3.861)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e(1.728)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e(4.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e(2.367)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e(2.405)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.038*\u003c/p\u003e\n \u003cp\u003e(-1.704)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.012\u003c/p\u003e\n \u003cp\u003e(-1.138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.026**\u003c/p\u003e\n \u003cp\u003e(-2.465)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.014*\u003c/p\u003e\n \u003cp\u003e(-1.783)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.042*\u003c/p\u003e\n \u003cp\u003e(-1.692)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.028\u003c/p\u003e\n \u003cp\u003e(-1.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eHealth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.128\u003c/p\u003e\n \u003cp\u003e(-1.112)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.085\u003c/p\u003e\n \u003cp\u003e(-1.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.136\u003c/p\u003e\n \u003cp\u003e(-1.264)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.105\u003c/p\u003e\n \u003cp\u003e(-1.008)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.125\u003c/p\u003e\n \u003cp\u003e(-1.154)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.186\u003c/p\u003e\n \u003cp\u003e(-1.085)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAs illustrated in Table 4, the extant research on the impact of social health insurance on intergenerational health support has focused on the role of socioeconomic status. The quality of social health insurance exerts divergent \u0026quot;crowding-in\u0026quot; and \u0026quot;crowding-out\u0026quot; effects on older adults of differing socioeconomic status. As demonstrated in Table 4, the \u0026quot;crowding out\u0026quot; effect of higher socioeconomic status older adults in obtaining intergenerational health care cost support from their children is more pronounced. The marginal effect calculations reveal that an increase in satisfaction with treatment outcomes leads to a 31.5% and 20.7% reduction in the probability of obtaining support for intergenerational medical expenses for older adults with high and low socioeconomic status, respectively. Similarly, an increase in satisfaction with the fairness of treatment results in a 22% decrease in the probability of obtaining support for intergenerational medical expenses. 5% and 12.1% for the older adults with high and low socioeconomic status, respectively. This finding indicates that the effect of social medical insurance on the older adults with higher socioeconomic status is more pronounced than that of intergenerational support for medical expenses. This finding suggests that social health insurance functions as an additional resource for older adults with higher socio-economic status, thereby enhancing their capacity to manage health challenges. Secondly, the quality of social health insurance has a stronger \u0026quot;crowding-in\u0026quot; effect on intergenerational health care support for older adults with higher socio-economic status. The calculation of the marginal effect demonstrates that an increase in satisfaction with the level of treatment results in a 36.6% and 10.2% probability of obtaining intergenerational health care support for older adults with high and low socioeconomic status, respectively. The findings indicate that the impact of enhancing satisfaction with the fairness of treatment on the acquisition of intergenerational medical care support by older adults with low socioeconomic status is not significant. This phenomenon is not only related to the concept of \u0026quot;self-support\u0026quot; among older adults in China, but also to the high level of survival pressure faced by lower socioeconomic groups. Furthermore, the quality of social health insurance exerts a more pronounced \u0026quot;crowding-in\u0026quot; effect on the intergenerational psychosocial support from children for older adults with low socioeconomic status. The calculation of marginal effects demonstrates that an increase in satisfaction with the level of treatment results in a 12.6% and 24.7% increase in the probability of obtaining intergenerational psychological support for older adults with high and low socioeconomic status, respectively. A similar increase in satisfaction with the fairness of treatment leads to a 2.8% and 8.3% increase in the probability of obtaining intergenerational psychological support for older adults with high and low socioeconomic status, respectively. This finding suggests that older adults with lower economic status encounter heightened survival pressure but diminished risk tolerance. The findings indicate that the integration of social health insurance coverage has the potential to augment the financial reserves of this demographic, foster enhanced intra-family trust, mitigate the risk of intergenerational resource mobility, and encourage children to be more inclined to provide bottom-up intergenerational psychological support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Impact of social health insurance on intergenerational health care support - regression analysis by economic status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"123%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eIntergenerational Medical Cost Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eIntergenerational Medical Care Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eIntergenerational Psychological Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eQuality of social health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eHigh socio-economic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eLow socio-economic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eHigh socio-economic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eLow socio-economic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eHigh socio-economic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eLow socio-economic status\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eSatisfaction with Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.315**\u003c/p\u003e\n \u003cp\u003e(-2.382)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.207***\u003c/p\u003e\n \u003cp\u003e(4.225)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.366***\u003c/p\u003e\n \u003cp\u003e(4.347)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.102**\u003c/p\u003e\n \u003cp\u003e(2.138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.126**\u003c/p\u003e\n \u003cp\u003e(1.706)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.247**\u003c/p\u003e\n \u003cp\u003e(2.034)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eLevel of Equity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.225***\u003c/p\u003e\n \u003cp\u003e(-3.589)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.121**\u003c/p\u003e\n \u003cp\u003e(-2.476)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.051**\u003c/p\u003e\n \u003cp\u003e(2.325)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003cp\u003e(1.026)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.028**\u003c/p\u003e\n \u003cp\u003e(2.514)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.083***\u003c/p\u003e\n \u003cp\u003e(3.228)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.018**\u003c/p\u003e\n \u003cp\u003e(2.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.025***\u003c/p\u003e\n \u003cp\u003e(3.762)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.014**\u003c/p\u003e\n \u003cp\u003e(2.118)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.035**\u003c/p\u003e\n \u003cp\u003e(2.067)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.024**\u003c/p\u003e\n \u003cp\u003e(2.359)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.087**\u003c/p\u003e\n \u003cp\u003e(1.998)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eGenders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.158\u003c/p\u003e\n \u003cp\u003e(-1.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.065\u003c/p\u003e\n \u003cp\u003e(-1.099)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.351\u003c/p\u003e\n \u003cp\u003e(-1.185)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.328\u003c/p\u003e\n \u003cp\u003e(-1.259)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.202\u003c/p\u003e\n \u003cp\u003e(-1.072)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.242\u003c/p\u003e\n \u003cp\u003e(-1.356)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMatrimonial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.682**\u003c/p\u003e\n \u003cp\u003e(-2.371)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.523**\u003c/p\u003e\n \u003cp\u003e(-2.442)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.682\u003c/p\u003e\n \u003cp\u003e(-1.258)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.614**\u003c/p\u003e\n \u003cp\u003e(-2.483)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.774**\u003c/p\u003e\n \u003cp\u003e(-2.329)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.685**\u003c/p\u003e\n \u003cp\u003e(-2.075)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.541***\u003c/p\u003e\n \u003cp\u003e(4.027)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.386*\u003c/p\u003e\n \u003cp\u003e(1.835)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.725**\u003c/p\u003e\n \u003cp\u003e(2.051)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.441*\u003c/p\u003e\n \u003cp\u003e(1.662)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.712*\u003c/p\u003e\n \u003cp\u003e(1.728)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.357*\u003c/p\u003e\n \u003cp\u003e(1.835)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eHousehold Registration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.251**\u003c/p\u003e\n \u003cp\u003e(-2.311)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.124**\u003c/p\u003e\n \u003cp\u003e(-2.046)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.035*\u003c/p\u003e\n \u003cp\u003e(-1.785)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.158*\u003c/p\u003e\n \u003cp\u003e(-1.774)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.028**\u003c/p\u003e\n \u003cp\u003e(-2.435)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.089*\u003c/p\u003e\n \u003cp\u003e(-1.899)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.047\u003c/p\u003e\n \u003cp\u003e(-1.044)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.038*\u003c/p\u003e\n \u003cp\u003e(-1.685)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.015\u003c/p\u003e\n \u003cp\u003e(-1.056)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.018\u003c/p\u003e\n \u003cp\u003e(-1.302)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.026*\u003c/p\u003e\n \u003cp\u003e(-1.715)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.025\u003c/p\u003e\n \u003cp\u003e(-1.058)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eHealth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.258\u003c/p\u003e\n \u003cp\u003e(-0.829)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.089\u003c/p\u003e\n \u003cp\u003e(-0.921)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003cp\u003e(1.052)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003cp\u003e(1.128)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003cp\u003e(1.071)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003cp\u003e(1.147)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAs illustrated in Table 5, the results of the mediating effects of economic improvement and health improvement are reported. As illustrated in Table 5, the economic performance and health performance of social health insurance mediated the enhancement in the level of intergenerational care support for older adults. In terms of improving economic status, the mediating effect of economic performance of social health insurance on intergenerational care support was found to be the most significant (\u0026beta; = 0.042, 95% CI [0.025-0.059]), suggesting that improving economic status contributes more indirectly to intergenerational care support. Conversely, the effect value of intergenerational psychological support was 0.037 with a 95% CI of 0.016-0.063, suggesting that improving economic status also indirectly enhances intergenerational psychological support to a certain extent. Although the effect value of intergenerational medical cost support is comparatively lower, it remains positive, signifying that enhancing economic status exerts a favourable indirect effect on intergenerational medical cost support. The findings indicate that the health status of older adults exerts a significant influence on intergenerational medical cost support, while psychological support is less impacted. This suggests that enhancing the health status of older adults can potentially augment intergenerational medical cost support and psychological support to a certain extent. For medical care support, the effect value was only 0.008 (95% CI: 0.006-0.013), suggesting that the indirect effect of improved health status on intergenerational care support is limited, but still not negligible. Consequently, the joint effect of enhanced economic status and health status on intergenerational support can be considered as indirect yet significant. The direct effects analysis yielded a -0.051 result (95% CI: -0.108 to -0.004) for the direct effect of social health insurance on intergenerational health care cost support, indicating a reduction in such costs. Conversely, for intergenerational medical care support and intergenerational psychological support, the direct effects were 0.482 and 0.282, respectively, with confidence intervals excluding zero, indicating that they directly caused an increase in care support and psychological support. Conversely, in the context of intergenerational medical cost support, the indirect effect accounted for 80.39% of the direct effect, suggesting that the indirect effect plays a predominant role in enhancing intergenerational medical cost support for older adults through social health insurance. Conversely, in the context of intergenerational care support and intergenerational psychological support, the percentage is comparatively lower, signifying that the direct effect is more pronounced in these two domains.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Analysis of mediating effects\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"726\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eIntergenerational Medical Cost Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eIntergenerational Medical Care Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eIntergenerational Psychological Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eEffect value (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003estandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eefficiency value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003estandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eefficiency value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003estandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eind_eff(\u0026nbsp;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.014-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.025-0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.016-0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eind_eff(\u0026nbsp;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.009-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.006-0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.012-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eind_eff(\u0026nbsp;total)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.028-0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.018-0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.015-0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003edir_eff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e-0.108-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.325-0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0..035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.146-0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eInd_eff /dir_eff %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e80.39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e9.75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e7.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: ind_eff( 1) represents the indirect effect of improved economic status, ind_eff( 2) represents the indirect effect of improved health status, and ind_eff( total) represents the total indirect effect; dir_eff represents the direct effect; ind_eff /dir_eff( %) represents the indirect effect as a percentage of the direct effect; Bootstrap Sampling was set to 2000.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe extant empirical studies have identified a direct correlation between the quality and implementation of social health insurance, as an integral component of the social security system, and the capital endowment of older adults. This, in turn, has a consequential impact on the intergenerational health care support available to older adults.\u003c/p\u003e\u003cp\u003eFirstly, the study identified that there are urban-rural differences in the impact of social health insurance quality on intergenerational health care support. In urban areas, the \"crowding out\" effect of the quality of social health insurance on intergenerational health care support is more pronounced due to a more comprehensive social health insurance system, higher accessibility of services and better prognosis. Conversely, in rural areas, the impact of social health insurance on intergenerational healthcare support is comparatively less pronounced, primarily due to the comparatively limited availability of healthcare resources and the lower popularity and quality of social health insurance services[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSecondly, the study revealed that there are discrepancies in the socioeconomic status of the older adults with regard to the impact of the quality of social health insurance on intergenerational health care support. Socioeconomic status is a comprehensive reflection of the capital endowment of the older adults, and the higher socioeconomic status of the older adults can satisfy their own basic medical service needs by virtue of their capital endowment. Therefore, insurance participation is not a primary factor in the decision, but rather an additional benefit. Conversely, individuals of higher socioeconomic status generally have more comprehensive social health insurance and medical protection, which serves to reduce their intergenerational reliance on their children for financial and care needs.In contrast, individuals of lower socioeconomic status have more restricted access to social health insurance and more limited access to medical costs, care services and prognostic measures, resulting in greater intergenerational dependence[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThirdly, the findings indicate that the quality of social health insurance has a tendency to \"crowd out\" children's intergenerational support for healthcare costs, and that the degree of crowding out is positively correlated with their socioeconomic status. This suggests that social health insurance interventions do reduce children's support for their parents' healthcare costs to some extent, but that this crowding out is more pronounced among older adults who are of higher socioeconomic status[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. The extent to which intergenerational health care support from children is diminished as social health insurance provides a greater range of specialised health care services is indicative of a 'crowding-in' effect. The \"crowding-in\" effect of the quality of social health insurance on intergenerational health care support from children is also stronger among older adults with higher socio-economic status, which is related to the higher awareness of insurance and health management among higher socio-economic status groups.\u003c/p\u003e\u003cp\u003eFourthly, the present study identifies the mediating role of the economic and health performance of social health insurance in improving the level of intergenerational medical support for older adults[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. The findings indicate that a combination of economic and health status enhancements can indirectly encourage diverse forms of intergenerational assistance in healthcare. However, the relative significance of indirect and direct effects exhibits variation across different categories of intergenerational support.\u003c/p\u003e"},{"header":"5. Conclusions and recommendations","content":"\u003cp\u003eIn summary, the impact of the quality of social health insurance on intergenerational medical support for older adults is a complex and multidimensional process, influenced by a variety of factors, including urban-rural differences, the socioeconomic status of older adults and the mediating role of social health insurance. In order to enhance the quality of life and sense of well-being of older adults, it is necessary to further improve the social health insurance system, enhance the quality of services, narrow the gap between urban and rural areas, raise the level of health insurance for low-income older adults, and take into full consideration the differences in the needs of different groups in order to formulate more targeted policy measures.\u003c/p\u003e\u003cp\u003eFirstly, the formulation of differentiated social health insurance policies for older adults of divergent socio-economic status is recommended, with the aim of enhancing the level of intergenerational medical support. Secondly, the coordination and harmonisation of social health insurance policies between urban and rural areas should be strengthened to reduce problems such as the wide disparity between urban and rural areas in terms of the impact of the quality of social health insurance on the standard of living of older adults, and the limited amelioration of intergenerational support imbalances. Finally, it is imperative to transcend the conventional economic paradigm and incorporate the long-neglected components of intergenerational medical support, namely medical care and psychological support.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data or models that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource(s) of support/funding:\u003c/strong\u003e This study was funded by the Major Projects of Philosophy and Social Science Research of the Ministry of Education (18JZD045).Supported by the Fundamental Research Funds for the Central Universities （2024lzujbkyqk006）. This study was funded by National Social Science Foundation of China (NSSFC) （22CRK014）.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of relationships and activities:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical approval for this study was granted by the Medical Ethics Committee of Xi'an Jiaotong University Health Sciences Center (Approval No. 2018-1200). The need for written informed consent was waived by the same ethics committee due to the anonymous and observational nature of the survey. All participants were informed about the study's purpose and the anonymity of their responses prior to their participation. Completion and return of the questionnaire were considered implied consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Thanks to the survey group of Xi’an Jiaotong University for the help in data collecting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003c/strong\u003e Zhang Chi: Conceptualization, Data curation, Formal analysis, Funding acquisition, Writing, Methodology, Project administration, Visualization; LongXuan Lin: Conceptualization, Supervision, Writing - review \u0026amp; editing;Xiaoyu Han: original draft, Writing, review \u0026amp; editing; Hengyuan Zhang: Data curation, Funding acquisition, Formal analysis;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLuo J, Cui M. For Children or Grandchildren?\u0026mdash;The Motivation of Intergenerational Care for the Elderly in China. International Journal of Environmental Research and Public Health. 2023;20:1441. https://doi.org/10.3390/ijerph20021441.\u003c/li\u003e\n\u003cli\u003eFields NL, Anderson KA, Dabelko-Schoeny H. The Effectiveness of Adult Day Services for Older Adults: A Review of the Literature From 2000 to 2011. J Appl Gerontol. 2014;33:130\u0026ndash;63. https://doi.org/10.1177/0733464812443308.\u003c/li\u003e\n\u003cli\u003eZhang X, Dupre ME, Qiu L, Zhou W, Zhao Y, Gu D. Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China. BMC Geriatrics. 2017;17:151. https://doi.org/10.1186/s12877-017-0538-9.\u003c/li\u003e\n\u003cli\u003eLi C, Jiang S, Zhang X. Intergenerational relationship, family social support, and depression among Chinese elderly: A structural equation modeling analysis. Journal of Affective Disorders. 2019;248:73\u0026ndash;80. https://doi.org/10.1016/j.jad.2019.01.032.\u003c/li\u003e\n\u003cli\u003ePerotti E, Schwienbacher A. The political origin of pension funding. Journal of Financial Intermediation. 2009;18:384\u0026ndash;404. https://doi.org/10.1016/j.jfi.2008.11.001.\u003c/li\u003e\n\u003cli\u003eRoss CE, Mirowsky J. Does Medical Insurance Contribute to Socioeconomic Differentials in Health? The Milbank Quarterly. 2000;78:291\u0026ndash;321. https://doi.org/10.1111/1468-0009.00171.\u003c/li\u003e\n\u003cli\u003eFolbre N. Reforming Care. Politics \u0026amp; Society. 2008;36:373\u0026ndash;87. https://doi.org/10.1177/0032329208320567.\u003c/li\u003e\n\u003cli\u003eArteaga O. Health Systems. In: Encyclopedia of Quality of Life and Well-Being Research. Springer, Cham; 2020. p. 1\u0026ndash;6. https://doi.org/10.1007/978-3-319-69909-7_3390-2.\u003c/li\u003e\n\u003cli\u003eJiang H, Zhao M, Tian G, Zhao Z, Ding D, Yin M. Perceived effect of financial risk protection by the Urban\u0026ndash;Rural Resident Basic Medical Insurance Scheme: a mixed-methods study of rural residents in China. BMJ Open. 2021;11:e047699. https://doi.org/10.1136/bmjopen-2020-047699.\u003c/li\u003e\n\u003cli\u003eRoss CE, Mirowsky J. Does Medical Insurance Contribute to Socioeconomic Differentials in Health? The Milbank Quarterly. 2000;78:291\u0026ndash;321. https://doi.org/10.1111/1468-0009.00171.\u003c/li\u003e\n\u003cli\u003eAnderson M, Dobkin C, Gross T. The Effect of Health Insurance Coverage on the Use of Medical Services. American Economic Journal: Economic Policy. 2012;4:1\u0026ndash;27. https://doi.org/10.1257/pol.4.1.1.\u003c/li\u003e\n\u003cli\u003eEhrlich I, Lui FT. Intergenerational Trade, Longevity, and Economic Growth. Journal of Political Economy. 1991;99:1029\u0026ndash;59. https://doi.org/10.1086/261788.\u003c/li\u003e\n\u003cli\u003eRoss CE, Mirowsky J. Does Medical Insurance Contribute to Socioeconomic Differentials in Health? The Milbank Quarterly. 2000;78:291\u0026ndash;321. https://doi.org/10.1111/1468-0009.00171.\u003c/li\u003e\n\u003cli\u003eDong K. Medical insurance system evolution in China. China Economic Review. 2009;20:591\u0026ndash;7. https://doi.org/10.1016/j.chieco.2009.05.011.\u003c/li\u003e\n\u003cli\u003eSloan FA, Zhang HH, Wang J. Upstream Intergenerational Transfers. Southern Economic Journal. 2002;69:363\u0026ndash;80. https://doi.org/10.1002/j.2325-8012.2002.tb00497.x.\u003c/li\u003e\n\u003cli\u003eCai F, Giles J, Meng X. How well do children insure parents against low retirement income? An analysis using survey data from urban China. Journal of Public Economics. 2006;90:2229\u0026ndash;55. https://doi.org/10.1016/j.jpubeco.2006.03.004.\u003c/li\u003e\n\u003cli\u003eYang Y, Evandrou M, Vlachantoni A. The impact of living arrangements and intergenerational support on the health status of older people in China: are rural residents disadvantaged compared to urban residents? Ageing \u0026amp; Society. 2023;43:469\u0026ndash;94. https://doi.org/10.1017/S0144686X21000702.\u003c/li\u003e\n\u003cli\u003eSilverstein M. Ten - Intergenerational Family Transfers in Social Context. In: Binstock RH, George LK, Cutler SJ, Hendricks J, Schulz JH, editors. Handbook of Aging and the Social Sciences (Sixth Edition). Burlington: Academic Press; 2006. p. 165\u0026ndash;80. https://doi.org/10.1016/B978-012088388-2/50013-4.\u003c/li\u003e\n\u003cli\u003eBai Y, Bian F, Zhang L, Cao Y. The Impact of Social Support on the Health of the Rural Elderly in China. International Journal of Environmental Research and Public Health. 2020;17:2004. https://doi.org/10.3390/ijerph17062004.\u003c/li\u003e\n\u003cli\u003eCook KS, Cheshire C, Rice ERW, Nakagawa S. Social Exchange Theory. In: DeLamater J, Ward A, editors. Handbook of Social Psychology. Dordrecht: Springer Netherlands; 2013. p. 61\u0026ndash;88. https://doi.org/10.1007/978-94-007-6772-0_3.\u003c/li\u003e\n\u003cli\u003eCropanzano R, Anthony EL, Daniels SR, Hall AV. Social Exchange Theory: A Critical Review with Theoretical Remedies. ANNALS. 2017;11:479\u0026ndash;516. https://doi.org/10.5465/annals.2015.0099.\u003c/li\u003e\n\u003cli\u003eLawler EJ. An Affect Theory of Social Exchange. American Journal of Sociology. 2001;107:321\u0026ndash;52. https://doi.org/10.1086/324071.\u003c/li\u003e\n\u003cli\u003eBrandt M, Deindl C. Intergenerational Transfers to Adult Children in Europe: Do Social Policies Matter? Journal of Marriage and Family. 2013;75:235\u0026ndash;51. https://doi.org/10.1111/j.1741-3737.2012.01028.x.\u003c/li\u003e\n\u003cli\u003eRaut LK, Tran LH. Parental human capital investment and old-age transfers from children: Is it a loan contract or reciprocity for Indonesian families? Journal of Development Economics. 2005;77:389\u0026ndash;414. https://doi.org/10.1016/j.jdeveco.2004.04.003.\u003c/li\u003e\n\u003cli\u003eAlbertini M, Kohli M, Vogel C. Intergenerational transfers of time and money in European families: common patterns \u0026mdash; different regimes? Journal of European Social Policy. 2007;17:319\u0026ndash;34. https://doi.org/10.1177/0958928707081068.\u003c/li\u003e\n\u003cli\u003eTeerawichitchainan B, Pothisiri W, Long GT. How do living arrangements and intergenerational support matter for psychological health of elderly parents? Evidence from Myanmar, Vietnam, and Thailand. Social Science \u0026amp; Medicine. 2015;136\u0026ndash;137:106\u0026ndash;16. https://doi.org/10.1016/j.socscimed.2015.05.019.\u003c/li\u003e\n\u003cli\u003eNg ST, Tey NP, Asadullah MN. What matters for life satisfaction among the oldest-old? Evidence from China. PLOS ONE. 2017;12:e0171799. https://doi.org/10.1371/journal.pone.0171799.\u003c/li\u003e\n\u003cli\u003eWu F. Intergenerational Support and Life Satisfaction of Older Parents in China: A Rural\u0026ndash;Urban Divide. Soc Indic Res. 2022;160:1071\u0026ndash;98. https://doi.org/10.1007/s11205-021-02672-0.\u003c/li\u003e\n\u003cli\u003eChen F, Short SE. Household Context and Subjective Well-Being Among the Oldest Old in China. Journal of Family Issues. 2008;29:1379\u0026ndash;403. https://doi.org/10.1177/0192513X07313602.\u003c/li\u003e\n\u003cli\u003eLiu M, Zhang Q, Lu M, Kwon C-S, Quan H. Rural and Urban Disparity in Health Services Utilization in China. Medical Care. 2007;45:767. https://doi.org/10.1097/MLR.0b013e3180618b9a.\u003c/li\u003e\n\u003cli\u003eLiu Y. Development of the rural health insurance system in China. Health Policy and Planning. 2004;19:159\u0026ndash;65. https://doi.org/10.1093/heapol/czh019.\u003c/li\u003e\n\u003cli\u003eLi J, Shi L, Liang H, Ding G, Xu L. Urban-rural disparities in health care utilization among Chinese adults from 1993 to 2011. BMC Health Services Research. 2018;18:102. https://doi.org/10.1186/s12913-018-2905-4.\u003c/li\u003e\n\u003cli\u003eBhandari H, Yasunobu K. What is Social Capital? A Comprehensive Review of the Concept. Asian Journal of Social Science. 2009;37:480\u0026ndash;510. https://doi.org/10.1163/156853109X436847.\u003c/li\u003e\n\u003cli\u003eToward a Theory of Familiness: A Social Capital Perspective | Semantic Scholar. https://www.semanticscholar.org/paper/Toward-a-Theory-of-Familiness%3A-A-Social-Capital-Pearson-Carr/b804bcd828c1b684c3b7101fca107ae435d2bd81. Accessed 3 Jan 2025.\u003c/li\u003e\n\u003cli\u003ede Souza EM, Grundy E. Intergenerational interaction, social capital and health: Results from a randomised controlled trial in Brazil. Social Science \u0026amp; Medicine. 2007;65:1397\u0026ndash;409. https://doi.org/10.1016/j.socscimed.2007.05.022.\u003c/li\u003e\n\u003cli\u003eGlass TA, Freedman M, Carlson MC, Hill J, Frick KD, Ialongo N, et al. Experience corps: Design of an intergenerational program to boost social capital and promote the health of an aging society. J Urban Health. 2004;81:94\u0026ndash;105. https://doi.org/10.1093/jurban/jth096.\u003c/li\u003e\n\u003cli\u003eMacha J, Harris B, Garshong B, Ataguba JE, Akazili J, Kuwawenaruwa A, et al. Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa. Health Policy and Planning. 2012;27 suppl_1:i46\u0026ndash;54. https://doi.org/10.1093/heapol/czs024.\u003c/li\u003e\n\u003cli\u003eMacfie J, Mcelwain NL, Houts RM, Cox MJ. Intergenerational transmission of role reversal between parent and child: Dyadic and family systems internal working models. Attachment \u0026amp; Human Development. 2005;7:51\u0026ndash;65. https://doi.org/10.1080/14616730500039663.\u003c/li\u003e\n\u003cli\u003eTsai-Chae AH, Nagata DK. Asian values and perceptions of intergenerational family conflict among Asian American students. Cultural Diversity \u0026amp; Ethnic Minority Psychology. 2008;14:205\u0026ndash;14. https://doi.org/10.1037/1099-9809.14.3.205.\u003c/li\u003e\n\u003cli\u003eSilverstein M, Conroy SJ, Gans D. Beyond solidarity, reciprocity and altruism: moral capital as a unifying concept in intergenerational support for older people. Ageing \u0026amp; Society. 2012;32:1246\u0026ndash;62. https://doi.org/10.1017/S0144686X1200058X.\u003c/li\u003e\n\u003cli\u003eSilverstein M, Gans D, Yang FM. Intergenerational Support to Aging Parents: The Role of Norms and Needs. Journal of Family Issues. 2006;27:1068\u0026ndash;84. https://doi.org/10.1177/0192513X06288120.\u003c/li\u003e\n\u003cli\u003eStrupat C, Klohn F. Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana. World Development. 2018;104:212\u0026ndash;21. https://doi.org/10.1016/j.worlddev.2017.11.004.\u003c/li\u003e\n\u003cli\u003eDekker M, Wilms A. Health Insurance and Other Risk-Coping Strategies in Uganda: The Case of Microcare Insurance Ltd. World Development. 2010;38:369\u0026ndash;78. https://doi.org/10.1016/j.worlddev.2009.09.004.\u003c/li\u003e\n\u003cli\u003eMurayama Y, Ohba H, Yasunaga M, Nonaka K, Takeuchi R, Nishi M, et al. The effect of intergenerational programs on the mental health of elderly adults. Aging \u0026amp; Mental Health. 2015.\u003c/li\u003e\n\u003cli\u003eTeixeira M, Martins MIC, Lamarca ICSA, Oliveira S. ABORDAGENS DO TRABALHO NO SETOR P\u0026Uacute;BLICO DE SA\u0026Uacute;DE: UMA REVIS\u0026Atilde;O NARRATIVA DA LITERATURA. Trab educ sa\u0026uacute;de. 2020;18 suppl 1:e0025688. https://doi.org/10.1590/1981-7746-sol00256.\u003c/li\u003e\n\u003cli\u003eChita State Medical Academy, Khodakova OV, Koshevaya NV, Chita State Medical Academy. INFORMATION SUPPORT OF THE INSURED CITIZENS AS INFLUENCING DISPENSERIZATION EFFICIENCY FACTOR. SMR. 2018;:84\u0026ndash;91. https://doi.org/10.20333/2500136-2018-6-84-91.\u003c/li\u003e\n\u003cli\u003eFang J, Liu L, Fang P. What is the most important factor affecting patient satisfaction \u0026amp;ndash; a study based on gamma coefficient. PPA. 2019;Volume 13:515\u0026ndash;25. https://doi.org/10.2147/PPA.S197015.\u003c/li\u003e\n\u003cli\u003eLiu L, Fang J. Study On Potential Factors Of Patient Satisfaction: Based On Exploratory Factor Analysis. PPA. 2019;Volume 13:1983\u0026ndash;94. https://doi.org/10.2147/PPA.S228073.\u003c/li\u003e\n\u003cli\u003eNee V. 3. The New Institutionalisms in Economics and Sociology. In: Smelser NJ, Swedberg R, editors. The Handbook of Economic Sociology. Princeton University Press; 2010. p. 49\u0026ndash;74. https://doi.org/10.1515/9781400835584.49.\u003c/li\u003e\n\u003cli\u003eGj\u0026oslash;lberg M. Explaining Regulatory Preferences: CSR, Soft Law, or Hard Law? Insights from a Survey of Nordic Pioneers in CSR. Bus polit. 2011;13:1\u0026ndash;31. https://doi.org/10.2202/1469-3569.1351.\u003c/li\u003e\n\u003cli\u003eTang S, Yang T, Ye C, Liu M, Gong Y, Yao L, et al. Research on grandchild care and depression of chinese older adults based on CHARLS2018: the mediating role of intergenerational support from children. BMC Public Health. 2022;22:137. https://doi.org/10.1186/s12889-022-12553-x.\u003c/li\u003e\n\u003cli\u003eLiu H, Li S, Feldman MW. Gender in Marriage and Life Satisfaction Under Gender Imbalance in China: The Role of Intergenerational Support and SES. Soc Indic Res. 2013;114:915\u0026ndash;33. https://doi.org/10.1007/s11205-012-0180-z.\u003c/li\u003e\n\u003cli\u003eSkropeta CM, Colvin A, Sladen S. An evaluative study of the benefits of participating in intergenerational playgroups in aged care for older people. BMC Geriatr. 2014;14:109. https://doi.org/10.1186/1471-2318-14-109.\u003c/li\u003e\n\u003cli\u003eGuo M, Chi I, Silverstein M. Intergenerational support and depression among Chinese older adults: do gender and widowhood make a difference? Ageing and Society. 2017;37:695\u0026ndash;724. https://doi.org/10.1017/S0144686X15001403.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Social Health Insurance Quality, Intergenerational Medical Support, Urban-Rural Differences, Older adults","lastPublishedDoi":"10.21203/rs.3.rs-7600300/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7600300/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eThe study addresses the growing concern of intergenerational support for the older adults amidst China's rapidly aging population and changing family structures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e The research utilizes data collected from 1,882 valid questionnaires administered to individuals across China's eastern, central, and western provinces in 2019 and 2021. Regression and mediation effect analyses were conducted to examine the impact of social health insurance quality on intergenerational healthcare support. The study also explores the mediating role of urban-rural differences and the socioeconomic status of older adults in this impact.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eSocial health insurance coverage is negatively associated with intergenerational health care cost support for the older adults, indicating that the social health insurance system plays a positive role in reducing the financial burden of family health care. Further analysis reveals that the impact of social health insurance quality on intergenerational medical support differs significantly between urban and rural areas, with the crowding-out effect being more pronounced in urban areas. The socioeconomic status of the older adults has a significant impact on the degree of intergenerational health care support, and the \"crowding out\" effect of social health insurance quality on intergenerational health care support is stronger among the older adults with higher socioeconomic status. The \"crowding-in\" effect of social health insurance quality on intergenerational health care support and intergenerational psychosocial support is stronger for older adults with higher socioeconomic status. Finally, the study found that the economic and health performance of social health insurance mediated the improvement of intergenerational health care support for the older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The study concludes that optimizing the social health insurance system requires the formulation of differentiated insurance policies that consider the different socioeconomic backgrounds of older adults. Strengthening the coordination of urban and rural social health insurance policies is suggested to narrow the service gap and upgrade the level of health insurance in rural areas.\u003c/p\u003e","manuscriptTitle":"The Impact of Social Health Insurance Quality on Intergenerational Medical Support for Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 07:34:38","doi":"10.21203/rs.3.rs-7600300/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"185604715975563140097828993598977375993","date":"2025-10-11T04:19:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7810725797371712209031548602331278265","date":"2025-10-09T16:39:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T11:32:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-07T03:50:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-17T08:40:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-17T00:40:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-17T00:36:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccc8be0a-4150-4245-95fa-723d91494cb1","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T07:34:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 07:34:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7600300","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7600300","identity":"rs-7600300","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}