Objective   To identify the characteristics associated with health insurance utilization and the association between the utilization and medical expenditure among middle-aged and elderly population in Henan province and to provide evidences for improving the process of national basic medical insurance.

  Methods   A questionnaire survey among 1 464 community residents aged 45 years and above was conducted in three cities of Henan province in August 2013.

  Results   Of the participants, 582 (39.8%), 1 134 (77.5%), and 1 215 (83.0%) reported inpatient treatment, outpatient treatment and self-treatment during previous 12 months. Among the participants reporting different medical treatments, 37 (6.4%), 666 (58.7%), and 928 (76.4%) didn’t use health insurance for their inpatient, outpatient, and self-treatment, respectively. For all the participants during the previous one year, the average individual medication related lost income, medical cost paid by insurance, gross total cost, and out of pocket cost were 749.2 ± 4 020.9, 3 194.4 ± 8 725.1, 10 828.2 ± 27 292.5, and 7 023.0 ± 21 919.1 yuan (RMB), respectively; the participants, who utilized health insurance for their inpatient treatment, reported significantly lower lost income (884.2 ± 2 864.0 vs. 2 182.4 ± 9 912.2), gross total cost (8 555.0 ± 16 401.3 vs. 22 230.5 ± 67 633.4 yuan), and out-of-pocket cost (674.6 ± 1 753.4 vs. 1 211.8 ± 2 258.1 yuan) compared to those who did not utilize medical insurance for their inpatient treatment (P < 0.05 for al).

  Conclusion   In Henan province, many middle-aged and elderly people didn’t use health insurance for their outpatient treatment and self-treatment, and the utilization of health medical insurance can reduce lost income, gross total cost, and out-of-pocket cost related to their inpatient medication.