Abstract:  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 to improve 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.

Key words: health insurance, health outcome, health care utilization, social support, health equality