This study examined the changing trajectory and factors that influenced the health and medical expenditure of the Chinese elderly population over the past two decades. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, inferential and multiple linear regression models were constructed. The key finding is that China has experienced a decoupling of healthcare demand (HCD) and healthcare expenditure (HCE) since around 2014, when HCE began to decline despite the fact that HCD continued to rise. This is a promising sign, suggesting that the government’s health insurance policy is working. Furthermore, participating in health insurance schemes can significantly reduce the elderly’s HCD and HCE, demonstrating that health insurance can effectively affect the elderly’s decision to seek medical treatment and improve their health condition. We also found that age, region, basic old-age insurance, and care by the government and institutions were significant factors that influenced the healthcare demand and expenditure of the elderly population.

Private (out-of-pocket) healthcare expenditure (PHCE) is a complex phenomenon that is shaped by many different factors. In this paper, we analyzed the influencing factors of PHCE in China, with a specific focus on regional differences. We found that old-age dependency ratio, income, and education have significant impacts on PHCE in all regions, whereas public HCE, number of beds in medical institutions, and economic development levels have significant impacts only in some regions. The results indicate that the government should pay attention to regional inequality and implement targeted adjustments for improving the health service system. In particular, we recommend: (1) monitoring regional inequality in PHCE and other healthcare issues to unmask geographical differences in healthcare interventions; (2) adopting regional-specific policy measures—the government should divert some resources from eastern to western and central regions to increasing the support for public health undertakings and improve the quality of the local health services while providing matching medical resources by targeting the needs of the residents; (3) paying more attention to the healthcare demand of the elderly population; and (4) improving the education level of residents to improve public health and avoid high PHCE.

Background: Given the growing healthcare demands of the elderly, an improved understanding of the factors influencing their healthcare-seeking behaviors is necessary to enhance the effectiveness of the current healthcare system. This study empirically investigates the factors influencing the elderly population’s healthcare-seeking behaviors in Shanghai, China, from a gender differences perspective.Methods: We combine both quantitative and qualitative analyses by constructing a binary logistic regression model and identifying the relevant influential factors based on the following types of dimensions: individual, family, and cultural.Results: The results indicate that gender differences exist in the elderly population with common diseases but not in those with severe diseases, and that the female elderly are more likely to choose non-tertiary hospitals than males. In addition, age, marital status, employment status, income, health conditions, medical insurance, family support, and social capital are found to be critical influencing factors.Conclusions: The findings provide a better understanding of the elderly population’s healthcare demands and can be used to promote healthcare equality.