The Interplay of Financial Support and Familial Duty: Adult Children's Contributions to Healthcare for Older Parents in Rural China.

Background: Older adults in rural China bear a significant proportion of their healthcare expenses through out-of-pocket payments, resulting in a considerable financial burden on their families. Objective: This study aimed to explore the key factors influencing adult children's involvement in financing healthcare expenses for their elderly parents in rural China. Methods: Data were collected by in-depth interviews using a semi-structured interview guide approved by all researchers. Inductive content analysis was employed to analyze data. A total of 15 participants were involved in the study. Results: Adult children primarily assume responsibility for their elderly parents' healthcare expenses in rural China, with occasional support from government subsidies. The principles guiding cost-sharing among adult children include filial piety, fairness, capability, and traditional gender roles. When adult children decline to take on the financial responsibilities, they may face pressure from the family members, the community, and local authorities, in some cases, elderly individuals may even resort to legal recourse. The state covers the healthcare expenses for older individuals without children through the "Five Guarantees" program and elder care institutions. Conclusion: This study highlights the financial dynamics within families in rural China, emphasizing the need for improved support systems to alleviate the burden on adult children and their elderly parents.