Abstract
BackgroundStroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in stroke patients’ health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China.MethodsA 5% random sample from the 2014–2016 China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data.ResultsWe found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMI patients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMI patients had significantly higher outpatient medical costs (RMB356.9) than URBMI patients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: − 0.672, − 0.649) fewer outpatient visits, 13.0% (95% CI: − 0.144, − 0.115) fewer inpatient visits, and 34.2% (95% CI: − 0.366, − 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference.ConclusionsSignificant city-specific differences in stroke patients’ healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of stroke patient access to health care.
Highlights
As the second most common cause of death, and one of most significant causes of disability, stroke is a leading global public health issue [1, 2]
Beijing had the largest proportion of Urban Employee Basic Medical Insurance (UEBMI) patients (48.1%) and the largest proportion of outpatients (54.0%); Chongqing had the most inpatients (42.9%) and the highest proportion of Urban Residents Basic Medical Insurance (URBMI) patients (66.3%)
Reflecting the broad differences between the UEBMI and URBMI scheme conditions, 15.9 days average length of hospital stay (ALOS) for UEBMI was significantly longer than 10.6 ALOS for URBMI
Summary
As the second most common cause of death, and one of most significant causes of disability, stroke is a leading global public health issue [1, 2]. Increasing stroke incidence, and higher survival rates, imposed a significant financial burden on China’s health care system [6,7,8], estimated to be about $US6 billion in 2011 [9]. The general UEBMI and URBMI schemes varied by the sources of funding, benefit packages, service coverage and financial protection [15,16,17,18]. There were significant differences in health care access and benefits in the 333 different cities for the UEBMI and URBMI insured. While existing studies focused mainly on differences in stroke patients’ health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China
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