The influence of the utilization of health insurance on the relationship between health shocks and poverty vulnerability among rural elderly in China: A study of different household structures

Abstract

Objectives

The study aimed to clarify the mechanism linking health shocks, health insurance utilization and poverty vulnerability among households of rural elderly in China, and explore the effect of household structure on the mechanism.

Study design

Cross-sectional study.

Methods

Data were obtained from an on-site survey supported by China's National Natural Science Foundation in 2022, targeting rural elderly with chronic diseases and their families. In total, 2169 Chinese rural residents aged ≥60 years with chronic diseases and their families were interviewed. Health shocks were represented as a latent variable comprising five specific variables. Health insurance usage was categorized into three options. Poverty vulnerability was assessed with a poverty line standard of $1.9 per capita daily consumption. Household structures were classified into three types. A structural equation model was constructed to explore the mechanism between these factors in the total study population and different household types. Entropy weight method assessed health shock scores. The Karlson-Holm-Breen (KHB) mediation decomposition method was applied to decompose the mediating effect of health insurance utilization in empty-nest and left-behind children's households.

Results

Findings showed that health insurance utilization mediates the link between health shocks and poverty vulnerability (a = 0.061, b = −0.01, c = 0.119; all P < 0.05). No mediation was observed in expand core households; however, in empty-nest and left-behind children's households, significant effects were seen (for empty-nest elder households, a = 0.032, b = −0.043, c = 0.078; for left-behind children's households, a = 0.066, b = −0.025, c = 0.123; all P < 0.05). The utilization of basic health insurance and medical financial assistance exhibits the highest mediation decomposition values among empty-nest and left-behind children's households, reaching 87.31 % and 64.89 %, respectively.

Conclusions

Health insurance utilization is crucial for countering health shocks and poverty vulnerability among rural households; however, its efficacy differs among household structures.