JMIR Publications

ABSTRACT

Background:

Catastrophic health expenditure (CHE) reflects healthcare inequity, particularly affecting vulnerable groups in rapidly developing multi-ethnic regions.

Objective:

This study aims to analyze CHE incidence, intensity, and their influencing factors among residents in a Chinese multi-ethnic province.

Methods:

Data from the 2023 Health Services Survey of Hainan province (n=14,532, ≥ 18 years) used multi-stage stratified cluster sampling. CHE was defined as out-of-pocket healthcare payments exceeding 40% of the household capacity to pay. Chi-square test and logistic regression were employed to identify influencing factors of CHE incidence. Nonparametric tests and quantile regression were used to evaluate influencing factors of CHE intensity.

Results:

In Hainan province, CHE incidence was 8.37% with 17.67% intensity. Residents were more likely to experience CHE if they were >60 years (OR=1.928, P<0.001), unmarried (OR=1.241, P<0.01), and had chronic illnesses (OR=2.214, P<0.001). Ethnic minorities (OR=0.774, P<0.001) as well as middle-, high-middle-, and high-income groups (OR=0.722; OR=0.739; OR=0.591, both P<0.01) were less likely to experience CHE. At lower CHE intensity (Q20), over 60 years (β=1.935, P<0.05), middle-income (β=1.737, P<0.05) and rural (β=2.202, P<0.01) residents showed positive associations. At Q50, low-middle- (β=-5.052, P<0.01), high-middle- (β=-4.203, P<0.05) and high-income (β=-6.534, P<0.01) groups showed negative associations. At Q80, high-middle-income (β=-7.143, P<0.05) and rural (β=-6.241, P<0.01) groups showed stronger protection.

Conclusions:

Addressing CHE risks remains a critical challenge in Hainan province, highlighting structural inequities rooted in socioeconomic disparities and health vulnerabilities. Policymakers should optimize cost-control and risk-sharing mechanisms to alleviate the healthcare economic burden, particularly targeting vulnerable populations.