Healthcare resource accessibility and farmers' health in rural China: a multidimensional perspective

Farmers' health capital is vital for global agriculture, yet farmers face multifaceted health risks. Using the China Family Panel Studies (CFPS) and China Statistical Yearbook data, this study employs fixed-effects, instrumental-variable, and quantile regression models to examine how geographic, economic, and social accessibility to healthcare affect farmers' health in China. Economic accessibility exerts the largest and most consistent effect, particularly among older farmers and those in central and western regions. Geographic accessibility shows a counterintuitive negative association, revealing reverse causality where poorer health drives long-distance care-seeking. Social accessibility yields modest gains, becoming more important among healthier farmers and uniquely significant in the western region. Heterogeneity analysis shows stronger associations among farmers with lower educational attainment, especially for geographic and social accessibility. For lower-income farmers, financial protection alone may be insufficient and should be complemented by health education. By constructing a multidimensional framework and identifying subgroup-specific effects, this study provides evidence for targeted policies integrating financial protection, infrastructure investment, and community-embedded care to address heterogeneous barriers across rural China.