Debates about the relationships between health insurance ,healthcare utilization and health outcomes in the empirical studies at home and abroad are not over yet .What has been empirically confirmed is the positive correlation between health insurance and healthcare utilization although direct associations between health insurance and health outcomes are not clear .Only when health insurance has the improvement of people’s health as its ultimate goal can it be said as being effective and fair .However ,examining health outcomes is absent in the assessment of the current health insurance reform . The outcomes of statistical analyses of the data of 2010 Sampling Survey of the Status of the Elderly in Urban and Rural China (Zhejiang Province) suggested that the sole concentration on expanding insurance coverage would not be enough .More importantly ,attention should be given to the equality in healthcare and health outcomes across different insurance plans .A one-way ANOVA analysis demonstrated unequal disparities in participation in health insurance plans and health outcomes among the older adults .Multiple linear regressions showed the significance of health insurance coverage as an independent variable in predicting health outcomes but this significance was replaced by the significant effects of specific insurance plans .Analyses of the interactions revealed a main negative relationship between healthcare utilization and health outcomes but health insurance ,as a moderator , could improve the health status of the older adults who utilized healthcare more , although the effect of the New Rural Cooperative Medical System (NRCMS) was in the opposite direction .The mediating effects of health insurance on older adults’ health outcomes were a function of the individual and structural factors such as socio-economic status and number of chronic diseases but social support and social networks should be included as influencing factors as well . This study has concluded that reflecting upon the health insurance reform is needed as the universal health insurance is not only toimprove the accessibility to the service in the healthcare system but also to guarantee the equal medical welfare entitlement across different social groups ,and ultimately ,to obtain equal health outcomes .At present ,however ,NRCMS resulting from the differentiated treatment in different insurance plans and the vulnerability of the urban older adults with health insurance and those without in receiving healthcare benefits have led to their poorer health and their inferior status in terms of equal health outcomes .%本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为，对于老年人的社会医疗保险问题，不仅要关注保险覆盖面的扩大，更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上，研究发现，职工医保作为moderator可以改善使用较多医疗服务老人的健康水平，新农合的作用则相反。研究希望对医疗保险的改革思路进行反思，全民医保的改革思路不仅是医疗服务可及性的提高，更应该是不同社群享有平等的医疗福利，并最终促进健康结果的平等。
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