Financial burden of older inpatients with multimorbidity in China: a cross-sectional study

Background In China, which has the world’s largest and one of the fastest-aging populations, multimorbidity has become a major public health challenge. Older individuals with multiple chronic conditions experience poor health outcomes, increased healthcare utilization, and substantial financial pressure. This study investigates of the financial burden on older inpatients with multimorbidity. Methods Utilizing 2022 inpatient data from a Chinese city (covering 4 secondary and 2 tertiary hospitals), this study employed descriptive statistics (means, standard deviations, medians, and interquartile ranges), comparative tests (chi-square, t -test, ANOVA), and multiple linear regression to identify key drivers of medical costs and out-of-pocket expenses for older inpatients with multimorbidity. Results The study revealed a high multimorbidity rate of 73.8% among 106,202 inpatients aged ≥50 years from six Chinese hospitals in 2022. The average total hospitalization cost was 10,318 yuan, with an out of pocket expense (OOPE) of 4,558 yuan. Descriptive analysis showed the largest patient proportion was aged 60–69 years (38.4%) and most had 2–4 chronic conditions. Analysis of medical expenses identified significant variations. Patients with urban employee insurance had higher total costs but lower OOPE (24.99% proportion) compared to those with urban–rural resident insurance (50.89% proportion). Treatment in tertiary hospitals and longer hospital stays were strongly associated with higher costs. Multiple regression confirmed hospital level, length of stay, and surgical intervention were the most significant positive predictors of total costs. For OOPE, health insurance type, hospital level, and length of stay were major influencing factors. Conclusion Multimorbidity is highly prevalent and imposes a substantial financial burden on older inpatients. Strengthening prevention, optimizing insurance design, and improving integrated care are essential for promoting healthcare equity and sustainability in China.