Xing Yiqing, Tarimo Clifford Silver, He Ruibo, Li Haomiao, Ren Weicun, Zhang Liang
School of Political Science and Public, Administration Wuhan University, 299 Bayi Road, Wuhan City, 430072, China.
College of Public Health, Zhengzhou University, Zhengzhou, 450001, China.
BMC Public Health. 2025 May 28;25(1):1968. doi: 10.1186/s12889-025-23195-0.
Middle-aged and older people are high-risk groups for chronic disease morbidity, and the healthcare expenditure burden they face has become an important social issue that must be addressed. Although the internet serves as a key tool for health management, little is known about its role in the healthcare expenditure of these groups. This study aims to explore how internet usage is associated with healthcare expenditure among middle-aged and older adults with chronic conditions, along with the underlying mechanism.
The study employed data from the Chinese Family Panel Survey (CFPS) conducted between 2014 and 2018. The sample was restricted to individuals aged 45 years or above with chronic diseases (n = 12,601). The fixed effects model was used to investigate the relationship between internet usage and healthcare expenditure of respondents. Instrumental variable method, subsample regression, supplementary variable method and propensity score matching were adopted to test robustness. The Karlson-Holm-Breen method and an IV-based mediation method were also used to assess the mediating effect of self-rated health.
Findings indicate that internet usage is significantly associated with lower healthcare expenditure burden among respondents (β = -0.068, P < 0.001). Self-rated health plays a mediating role in the relationship between internet usage and healthcare expenditure, accounting for 30.14% of the effect. Heterogeneity analysis reveals that internet usage is significantly associated with lower other expenditures (β = -0.112, P < 0.001) while being associated with higher hospital expenditure (β = 0.094, P < 0.05). Analysis of urban-rural heterogeneity further reveals that internet usage is significantly associated with higher hospital expenditure in rural areas (β = 0.145, P < 0.05). However, the association between internet usage and other expenditures in urban areas (β = -0.217, P < 0.001) is greater than that in rural areas (β = -0.035, P < 0.01).
These findings highlight internet usage is associated with a lower expenditure burden of middle-aged and older adults with chronic diseases in China, mediated by high self-rated health. In addition, urban-rural disparities in the association between internet usage and healthcare expenditure are significant.
中老年人是慢性病发病的高危人群，他们面临的医疗支出负担已成为一个必须解决的重要社会问题。尽管互联网是健康管理的关键工具，但对于其在这些人群医疗支出中的作用却知之甚少。本研究旨在探讨互联网使用与患有慢性病的中老年人医疗支出之间的关联以及潜在机制。
本研究采用了2014年至2018年期间开展的中国家庭追踪调查（CFPS）的数据。样本仅限于45岁及以上患有慢性病的个体（n = 12,601）。固定效应模型用于研究受访者的互联网使用与医疗支出之间的关系。采用工具变量法、子样本回归、补充变量法和倾向得分匹配法来检验稳健性。还使用卡尔森 - 霍尔姆 - 布林方法和基于工具变量的中介效应方法来评估自评健康的中介效应。
研究结果表明，互联网使用与受访者较低的医疗支出负担显著相关（β = -0.068，P < 0.001）。自评健康在互联网使用与医疗支出的关系中起中介作用，并占该效应的30.14%。异质性分析表明，互联网使用与较低的其他支出显著相关（β = -0.112，P < 0.001），而与较高的住院支出相关（β = 0.094，P < 0.05）。城乡异质性分析进一步表明，互联网使用与农村地区较高的住院支出显著相关（β = 0.145，P < 0.05）。然而，互联网使用与城市地区其他支出之间的关联（β = -0.217，P < 0.001）大于农村地区（β = -0.035，P < 0.01）。
这些研究结果表明，在中国，互联网使用与患有慢性病的中老年人较低的支出负担相关，自评健康状况良好起到了中介作用。此外，互联网使用与医疗支出之间的关联存在显著的城乡差异。
