Zhan Shu, Zefang Wei, Zhenfei Huang, Mingyuan Dong School of Public Administration, Central China Normal University, Wuhan, Hubei, People’s Republic of ChinaCorrespondence: Zefang Wei, School of Public Administration, Central China Normal University, Wuhan, Hubei, 430079, People’s Republic of China, Tel +86 139 5376 7959, Email weizefang14@163.comBackground: The correlation between health shocks and debt risk among middle-aged and elderly individuals in China remains inadequately explored. This study seeks to investigate the relationship between health shocks and household debt risk, considering the mediating roles of self-treatment, outpatient care, and inpatient care.Methods: A cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 wave, including 19,670 middle-aged and older adults in China. Linear regression models were first employed to examine the association between health shocks and household debt risk. Sobel tests were then employed to explore the mediating roles of informal self-treatment, outpatient care, and inpatient care.Results: The findings reveal a significant and positive association between health shocks and cash debt risk among middle-aged and elderly individuals in China. Notably, individuals with a higher burden of chronic diseases, particularly those in middle age, exhibit an elevated risk of cash debt. Furthermore, informal self-treatment emerges as a crucial mediator in the relationship between health shocks and cash debt risk. Conversely, formal healthcare utilization demonstrates no significant mediating effect.Conclusion: This study underscores the urgent need to strengthen financial protection for individuals with chronic diseases and multimorbidity. Policy efforts should focus on expanding outpatient reimbursement, improving the capacity and integration of primary healthcare services, and establishing more effective and coordinated management strategies for multimorbidity in order to alleviate long-term debt risk.Keywords: health shocks, debt risk, mediating roles, self-treatment, healthcare utilization, sobel test
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