Impact of Healthcare Financial Stress on Residents' Subjective Well-Being: Health Status and Household Disposable Income as Mediators.

Amid rapid population aging and the rising prevalence of chronic diseases, healthcare-related financial stress has become a critical risk factor undermining residents' subjective well-being. Using micro panel data from the China Family Panel Studies (CFPS) for 2018 to 2022, this study examines the impact of healthcare financial stress on subjective well-being and its underlying mechanisms. Two-way fixed-effects models are employed, controlling for individual and time fixed effects and a wide set of demographic and household characteristics. We estimate the association between healthcare financial stress and happiness scores and use mediation analysis to assess the roles of self-rated health status and freely disposable household income in transmitting this effect. The results indicate that, after controlling for individual and time fixed effects as well as a range of demographic and household characteristics, healthcare financial stress is significantly negatively associated with subjective well-being. Mediation analysis shows that healthcare financial stress worsens self-rated health and compresses disposable income, thereby amplifying its adverse effect on well-being. Heterogeneity analysis further reveals that low-income groups, rural residents, and individuals with limited social security coverage bear a disproportionately larger negative impact, suggesting that healthcare financial stress constitutes an important constraint on advancing common prosperity. Accordingly, this study recommends advancing a "quasi-free" reform of basic healthcare, accompanied by optimizing the financing and expenditure structure and strengthening health insurance payment and oversight, to alleviate healthcare financial stress, enhance well-being, and improve the healthcare security system.