Trends and determinants of healthcare-induced poverty in China 2013-2019

Healthcare costs are a major driver of poverty, accounting for 44.1% of poverty cases in China. By 2015, nearly 20 million people fell into or returned to poverty due to health issues. In response, the Chinese government launched the national health poverty alleviation project in 2016. This study aims to evaluate the distribution and trends of healthcare-induced poverty from 2013 to 2019. Using data from the China Household Finance Survey (CHFS), we estimated the incidence of household catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and analyzed their determinants through multi-level logistic regression models. Subgroup analyses were conducted based on rural/urban location, geographic region, and province. In 2013, 31.83% of households experienced CHE, while 9.56% faced IHE. CHE incidence declined significantly after 2016 [adjusted odds ratio (AOR)  = 0.493-0.766, P < 0.001]. IHE incidence initially increased in 2015 (AOR = 1.580, P < 0.001) before declining from 2017 onward (AOR = 0.465-0.607, P < 0.001). The most significant reduction (9.99%-10.95%) occurred among the highest income quartile. CHE and IHE shared similar determinants. Higher odds of CHE and IHE were associated with older age of the household head (AOR = 1.225-2.175, P < 0.001), rural residency (AOR = 1.093-1.199, P < 0.05), the presence of an elderly household member (AOR = 1.237-1.336, P < 0.001), and having more household members in poor self-rated health (AOR = 2.455-4.137, P < 0.001). Conversely, lower odds of CHE and IHE were associated with higher educational attainment (AOR = 0.681-0.879, P < 0.001) and employment (AOR = 0.610-0.708, P < 0.001) of the household head, higher household income per capita (AOR = 0.017-0.860, P < 0.001), and larger household size (AOR = 0.335-0.684, P < 0.001). Households in urban areas and the eastern developed region had lower incidences of CHE and IHE compared to others. In conclusion, China has seen a significant decline in CHE and IHE, particularly after implementing the national poverty alleviation project. However, regional, urban-rural, and income-related disparities persist, underscoring the need for equity-focused interventions.