Objective  To examine the situation and influencing factors of medical expenses among the patients hospitalized in hospitals locating in the places other than their residential regions in Guangdong province.

  Methods  We extracted medical records of 5 355 cross-regional inpatients in 426 hospitals providing internet-based cross-regional healthcare in Guangdong province on August 2nd, 2017 and conducted a survey among the inpatients with a self-designed questionnaire. Descriptive statistics, chi-square test, and binary logistic regression were adopted in data analyses.

  Results  Of the patients surveyed, 3 402 (67.3%) had the cross-regional hospitalization due to the referrals based on their disease conditions and 2 230 (41.6%) reported an out-of-pocket medical expense accounting for more than 50% of their total family income during past 12 months. The burden of the hospitalization costs among the inpatients differed significantly by gender, age, educational level, average income per month, time of hospitalization, number of family member aged ≥ 65 years, number of family member aged ≤ 12 years, department of the hospitalization, and whether cared by a family member (P < 0.05 for all). The logistic regression analysis illustrated that female gender (odds ratio OR = 0.725, 95% confidence interval 95% CI: 0.629 – 0.836) , with a bachelor degree (OR = 0.612, 95% CI: 0.440 – 0.850), high monthly income (OR = 0.187, 95% CI: 0.086 – 0.408), with two family members aged ≥ 65 years (OR = 0.785, 95% CI: 0.645 – 0.954), cared by family members (OR = 0.576, 95% CI: 0.465 – 0.714) were the protective factors of the burden of medical expense; while, being a farmer (OR = 1.517, 95% CI: 1.179 – 1.953), time of hospitalization (OR = 9.356, 95% CI: 7.269 – 12.042), hospitalized in surgical department (OR = 1.357, 95% CI: 1.132 – 1.627) and oncology department (OR = 2.219, 95% CI: 1.737 – 2.835) were risk factors for the burden of medical expense.

  Conclusion  There is a strong demand for cross-regional medication and the burden of the cross-regional medication is impacted by gender, age, educational level, occupation, average monthly income, time of hospitalization, number of family members aged ≥ 65 years, department of hospitalization, and whether cared by family member among the cross-regional inpatients in Guangdong province.