ArticleFrontiers in public health2026
Effects of digital health education on expanding health insurance protection among university students: survey evidence from Shandong, China.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
Background: Although Chinese universities have rolled out the Basic Medical Insurance for Urban and Rural Residents (BMIUR) on a nearly universal basis, actual enrollment, knowledge of benefits, and real-world claim use remain uneven. Many students, particularly rural and first-generation entrants, commence the academic semester without having activated their accounts or understanding referral rules, leaving large pockets of under-protection. Methods: We exploit a campus-level natural experiment at a large public university in Shandong: on September 1, 2024, an institution-wide digital health education program was launched for incoming 2024 freshmen, while earlier cohorts (2021-2023) received no comparable intervention. Using a fuzzy regression discontinuity design (RDD) with enrollment date as the running variable, we estimate the effect of the program on a composite index of health insurance protection combining variables on enrollment status, policy knowledge, claim experience and satisfaction. Survey data of 4,872 students were merged with enrollment data. Robustness checks: several bandwidths, donut-RD, placebo cutoffs, propensity score matching. Heterogeneity is by hukou, only child status, and self-rated health. KHB mediation decomposed cognitive, behavioral and psychological channels (Cronbach's alpha = 0.82; Results: At the cutoff, enrollment jumped from 87.3 to 98.5% ( Conclusion: A comparatively benign, digital health education intervention can exert a significant positive effect on health insurance coverage expansion in a cohort of matriculating university students. There is evidence for scaling digital onboarding modules during enrollment, and maintaining support during annual enrollment, and it is cognition and through-the-hand activation, rather than diffusion of information only, that sticks.
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