In order to reduce the health damage caused by ecological environment pollution and alleviate the burden of residents' health expenditure, it is of great significance to study the impact of ecological environment quality on residents' health expenditure. In this study, we use the Ecological Environment Index (EI) in China from 2009-2019 and the SYS-GMM model. The conclusions are as follows: (1) The decline of ecological environment quality significantly increased residents' health expenditures. (2) The ecological environment mainly affects the residents' health expenditure through the health effect and driving effect. (3) Compared with economically developed regions and lower environmental emphasis, residents in economically undeveloped regions and high environmental emphasis are more sensitive to health expenditures. (4) Through a series of robustness test and use thermal inversion as an instrumental variable for endogeneity analysis, the regression results remain robust. Therefore, this study provides important evidence for further improving the ecological environment and reducing the residents’ health expenditures.