A study on the impact of catastrophic health expenditure on social stability

Objectives: To reveal the impact of catastrophic health expenditure (CHE) on social stability by examining individuals' sense of social equity and sense of social identity. Methods: Data from the 2023 Chinese Social Survey and an ordered logit model are used to analyze the impact of CHE on social stability from the dual perspectives of individuals' sense of social equity and sense of social identity. The individual sense of social equity is constructed using three evaluation dimensions: public healthcare, social security, and urban-rural rights and benefits. Meanwhile, the individual sense of social identity is developed based on three indicators: subjective well-being, life satisfaction, and social trust. Results: Compared to individuals without CHE, those with CHE report a significantly lower sense of social equity and social identity; their perceptions of public healthcare equity, social security equity, urban-rural rights and benefits equity, as well as subjective well-being, life satisfaction, and social trust are lower by 0.107, 0.132, 0.214, 0.205, 0.340 and 0.165, respectively. Moreover, with the increase in the intensity of catastrophic health expenditure, individuals' perceptions of public healthcare equity, social security equity, urban-rural rights and benefits equity, along with their subjective well-being, life satisfaction, and social trust decrease by 0.323, 0.292, 0.559, 0.630, 0.980, and 0.608, respectively. Conclusion: CHE diminishes individuals' perceptions of social equity and social identity, and a rise in its intensity exerts a further significant impact on social stability. Efforts should focus on optimizing the allocation of medical resources and adjusting fiscal input to advance equity in access to high-quality medical services, balancing gaps in medical insurance benefits and reducing individuals' medical expense burden, adjusting existing reimbursement policies, exploring the establishment of an income-related out-of-pocket payment ceiling mechanism to control out-of-pocket medical expenses, and avert the occurrence of CHE.