Objective  To explore current situation of catastrophic health expenditure (CHE) and its impact factors among rural families in Fushun county of Sichuan province and to provide references for improving reimbursement policies of New Rural Cooperative Medical System (NRCMS).

  Methods  We conducted a questionnaire survey among 4 370 rural residents of 1 056 households selected with multistage random sampling in Fushun county of Sichuan province between March and June 2016. Occurrence rate of CHE and the gap between out-of pocket expenditure (OOP) for CHE and family consumption expenditure were adopted in the study and binary logistic regression was used to identify associated factors of CHE.

  Results  For the CHE after the reimbursement of NRCMS during 2015 among 4 095 participants of 999 families with eligible data, the occurrence rate, the average gap, and the relative gap were 18.02%, 3.62%, and 20.11%, with the corresponding decreases of 30.77%, 38.44%, and 11.64% in comparison with those before the reimbursement, respectively. The occurrence rate of CHE due to hospitalization and outpatient cost declined by 41.59% and 8.18% after the reimbursement of NRCMS. Major impact factors of family CHE were times of hospitalization, dependency ratio, annual household income per capita, whether having a family member with chronic disease among the participants.

  Conclusion  The incidence and intensity of CHE are reduced after the establishment of NRCMS among rural residents and the efficiency of NRCMS reimbursement for hospitalization cost is better than that for outpatient medical service cost. While the CHE is still more likely to occur among families with a chronic disease sufferer or low annual income.