Background Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. Methods Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. Results The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011–2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. Conclusions Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.

Background: Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older.Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE.Results: The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35% to 22.37%) to 31.00% (95% CI: 29.28% to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71% to 3.53%) to 8.75% (95% CI: 8.14% to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99% to 16.92%) to 28.23% (95% CI: 26.26% to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type.Conclusions: Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.Trial Registration: None.

Introduction: Catastrophic health expenditures (CHE) among Chinese elderly is an issue worthy of attention. However, the incidence, intensity and determinants of CHE have not been fully investigated by previous studies. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e. those aged 60 years or older.Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. Cutoff points used in this study for catastrophic health expenditures were 10% of the total expenditures and 40% of non-food expenditures. Under the guidance of the Andersen model of health services utilization, this study used the logistic regression analysis to explore the determinants of catastrophic health expenditures.Results: The incidence of catastrophic health expenditures rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35% to 22.37%) to 31.00% (95% CI: 29.28% to 32.72%) with 40% non-food expenditure. The intensity of CHE had also increased. The Overshoot(O) rose from from 3.12% (95% CI: 2.71% to 3.53%) to 8.75% (95% CI: 8.14% to 9.36%) with 40% non-food expenditure, while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99% to 16.92%) to 28.23% (95% CI: 26.26% to 30.19%), which means that the problem of catastrophic health expenditures was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they: had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, are disabled; are members of a poor expenditure quartile, are located in the middle and western zones and reside in an Urban area. In contrast, catastrophic health expenditures were not significantly affected by age above 75 years, household size, having a chronic health condition or insurance type.Conclusion: Key policy recommendations include efforts to gradually improve medical assistance and to expand the use of health insurance to reduce household liability exposure for health expenditures.