Abstract
Background
In light of China's demographic transition towards an increasingly aged population coupled with a high prevalence of chronic conditions, there has been a pronounced augmentation of economic pressures on elderly households as well as on the national healthcare system. This research explores the determinants of catastrophic health expenditure (CHE) among Chinese households that include elderly individuals diagnosed with chronic diseases.
Methods
Utilizing data from the 2011 China Health and Retirement Longitudinal Study (CHARLS), conducted by the National School of Development at Peking University, this research focuses on households with at least one member aged 60 or older diagnosed with a chronic disease. CHE is measured by the proportion of out-of-pocket health payments in relation to total household expenditures, excluding food. The study constructed panel data from the follow-up surveys in 2015, 2018, and 2020, and used logistic regression to analyze the impact of various factors on CHE, including the presence of chronic diseases, age, education level, marital status, household registration (hukou), place of residence, and basic medical insurance coverage.
Result
The analysis indicates that chronic diseases significantly increase the likelihood of incurring CHE in elderly households, even if there is only one chronic illness. Key factors affecting CHE include age, education level, marital status, hukou, and residence. Notably, basic medical insurance did not significantly reduce the risk of CHE. Statistical data show that households with chronic diseases have a higher tendency toward CHE (P < 0.001, 95% CI: 1.36–1.64).
Conclusion
Chronic diseases have emerged as a dominant risk factor for catastrophic health expenditures (CHE) among elderly households in China, yet basic medical insurance has not adequately mitigated these expenditures.The findings highlight the urgent need for policy interventions to strengthen financial protections and enhance social health insurance schemes, thereby reducing the financial vulnerability of elderly households facing health shocks.