Catastrophic health expenditure and health-related quality of life among patients with chronic diseases: The moderation effect of family doctor contract services

This study evaluated the impact of catastrophic health expenditure (CHE) on health-related quality of life (HRQoL) among chronic disease patients and examined the moderating role of family doctor contract services, using data from the 2023 Heilongjiang Health Service Survey ( n = 1,124). HRQoL was assessed using the The EuroQol-5-dimension-5-level (EQ-5D-5L) scale, with CHE defined according to World Health Organization (WHO) standards. Tobit regression was employed to analyze both the CHE-HRQoL association and its modification by family doctor contract services. Robustness was verified through propensity score matching (PSM) using nearest-neighbor, radius and kernel methods. Results showed the mean EQ-5D utility score was 0.854, with CHE households demonstrating significantly lower health utility values (0.743) than non-CHE households (0.903). Regression analysis revealed: 1) CHE was associated with significant reductions ( β = −0.130, P < 0.001), which remained significant after covariate adjustment ( β = −0.063 , P < 0.001); 2) family doctor contract services showed significant moderating effects (interaction term β = 0.064, P = 0.024) ; and 3) age ≥ 60 years, comorbidities, and healthcare utilization were risk factors, while higher education and employment status showed protective effects. Consistent with these findings, PSM analysis confirmed significantly reduced health utility in CHE households (average treatment effect on the treated (ATT) = −0.076, 95% CI: −0.127 to −0.026), with consistent results across different matching methods, demonstrating the robustness of findings. The study indicates that CHE significantly reduces the HRQoL of chronic disease patients. Expanding family doctor service coverage especially for high-risk chronic disease populations may help alleviate the “poverty-disease” cycle. • Our study targets chronic disease families to alleviate the poverty-disease cycle. • Family doctors mitigate the negative impact of high health costs to well-being. • Expanding family doctor service coverage is recommended for chronic disease patients.