Association between livelihood capital and catastrophic health expenditure among patients with critical illness: a cross-sectional study in rural Shandong, China

OBJECTIVE: The objective of this study is to examine the association between livelihood capital and catastrophic health expenditure (CHE). DESIGN: Between July and August 2019, a cross-sectional study was conducted in critically ill patients. SETTING: Shandong, China. PARTICIPANTS: 1041 households with critically ill patients from 77 villages. PRIMARY AND SECONDARY OUTCOME MEASURES: We defined expenditure as being catastrophic if a household’s out-of-pocket payments were greater than or equal to 40% of their capacity to pay. Using the sustainable livelihoods framework, this study explored the associations between CHE and the various forms of livelihood capital—inclusive of human capital, natural capital, physical capital, financial capital and social capital. χ(2) tests, t-tests, Wilcoxon tests and binary logistic regression analysis were performed to examine these associations. RESULTS: The incidence of CHE among households with critically ill patients was 76.37% in this study. Better livelihood capital was significantly associated with lower incidence of CHE. After controlling for confounding factors, households with healthier patients (OR 0.47, 95% CI 0.23 to 0.96), more real estate ownership (OR 0.35, 95% CI 0.19 to 0.67) and better economic status (OR 0.33, 95% CI 0.18 to 0.62) were associated with a reduction in the occurrence of CHE. CONCLUSIONS: Livelihood capital was significantly associated with CHE in rural families with critically ill patients. This association suggests that, in addition to providing health insurance to the critically ill, more attention should be paid to their ability to create and preserve livelihood capital.