{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:06:25Z","timestamp":1789707985089,"version":"4.0.1"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n 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\u20132023) 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\u2019s alpha\u202f=\u202f0.82;\n F<\/jats:italic>\n \u202f&gt;\u202f200 in first stage).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At the cutoff, enrollment jumped from 87.3 to 98.5% (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.112, SE\u202f=\u202f0.018,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), knowledge of policy details rose from 42.1 to 93.6% (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.515,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), successful claim rate climbed from 87.2 to 97.7% (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.105,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), and composite satisfaction moved from 52.6 to 88.3 on a 0\u2013100 scale (\n \u03b2<\/jats:italic>\n \u202f=\u202f35.7,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). The claim denial rate decreased from 17.6 to 10.1%, representing a relative reduction of approximately 43% (risk difference\u202f=\u202f7.5 percentage points,\n p<\/jats:italic>\n \u202f=\u202f0.012). Effects are greatest for rural students, for non-only-children, and for those in poor or fair health. Cognitive and behavioral channels account for most of the mediation (42 and 30% of indirect effects, respectively), and the psychological channel of mediation amounts to 17%. The direct, unmediated residual effect is small and not statistically different from zero.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1964843","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:36:28Z","timestamp":1789706188000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of digital health education on expanding health insurance protection among university students: survey evidence from Shandong, China"],"prefix":"10.3389","volume":"14","author":[{"given":"Shuangtong","family":"Wang","sequence":"first","affiliation":[{"name":"School of Literature, Weifang University of Science and Technology","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Ma","sequence":"additional","affiliation":[{"name":"Media Convergence College, Woosong University","place":["Daejeon, South Chungcheong Province, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Sima","sequence":"additional","affiliation":[{"name":"School of Marxism, Luoyang Normal University","place":["Luoyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shouguang Software Park, Weifang University of Science and Technology","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qun","family":"Gao","sequence":"additional","affiliation":[{"name":"Shouguang People\u2019s Hospital","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhai","family":"Tang","sequence":"additional","affiliation":[{"name":"School of Literature, Weifang University of Science and Technology","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Wang","sequence":"additional","affiliation":[{"name":"Rushan No. 1 Middle School","place":["Weihai, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueming","family":"Xia","sequence":"additional","affiliation":[{"name":"School of Literature, Weifang University of Science and Technology","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1016\/S0140-6736(19)32136-1","article-title":"10 years of health-care reform in China: progress and gaps in universal health coverage","volume":"394","author":"Yip","year":"2019","journal-title":"Lancet"},{"key":"ref2","volume-title":"Opinion on Integrating the Basic Medical Insurance Systems for Urban and Rural Residents (Guofa [2016] No. 3)","year":"2016"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1097\/MLR.0000000000002157","article-title":"A text message outreach intervention to increase health insurance enrollment for self-pay patients","volume":"63","author":"Lu","year":"2025","journal-title":"Med Care"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.1072493","article-title":"Awareness of medical insurance reimbursement policy among university freshmen in eastern China","volume":"10","author":"Liu","year":"2023","journal-title":"Front Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2853","DOI":"10.1007\/s00520-021-06568-0","article-title":"Effectiveness of mobile health-based self-management interventions in breast cancer patients: a meta-analysis","volume":"30","author":"Luo","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e006046","DOI":"10.1136\/bmjopen-2014006046","article-title":"Are interventions for low-income groups effective in changing healthy eating, physical activity and smoking behaviors? 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Shandong Statistical Yearbook 2024","author":"Ma","year":"2024"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1964843\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:36:43Z","timestamp":1789706203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1964843\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":38,"alternative-id":["10.3389\/fpubh.2026.1964843"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1964843","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"article-number":"1964843"}}