Hospitalisation cost analysis of hip fracture in China: a cross-sectional, multicenter study

Abstract

BackgroundHip fracture is common, with high morbidity and expense, which becomes a major health-care problem. Very few multicenter studies of the cost of care for hip fracture in China have been done. The aim of this study was to describe and analyse the hospitalisation cost associated with hip fractures, to compare the hospitalisation cost with the local income level, and to provide rational proposals for Chinese national medical insurance policy. MethodsIn this multicenter, cross-sectional study, we collected and analysed data from Chinese National Medical Data Center Database. The inclusion criteria were based on the main diagnosis of femoral neck or intertrochanteric fracture and a discharge date between Dec 30, 2013, and Dec 31, 2015. Hospitalisation costs, age, diagnosis, treating methods, hospitalisation provinces, and hospitalisation length of stay were collected and analysed using SPSS 23.0. We excluded any datasets that did not have the full complement of information listed above. The gross domestic product (GDP) per capita and average annual disposable income were obtained from National Bureau of Statistics of the People's Republic of China. The effect of various factors on the cost of hospitalisation was investigated using ANOVA analysis and multivariable linear regression analysis. The level of significance was set at p<0·05. The choropleth maps of the hospitalisation cost, GDP per capita, and average annual disposable income was made using Excel 2007 to compare the distribution characteristics. Findings27 205 cases from 73 central hospitals in 24 provinces were included in the study. The average cost of all patients was ¥53 440 (median ¥51158, SD ¥35 238), which was more than the GDP per capita in 2014 (¥46 629) and 2·65 times the average annual disposable income of 2014 (¥20 167). According to the multiple linear regression analysis, the diagnosis, treatment methods, and length of hospital stay had a statistically significant effect on hospitalisation costs. Furthermore, some age groups (0–19 years, 60–69 years) also had significant effects. The average cost of care for patients with femoral neck fractures was ¥12 284·22 less than for the care of patients with intertrochanteric fractures, with the standardised coefficient of 0·263; the average cost of hip replacement was ¥18560·65 higher than that of internal fixation, with the standardised coefficient of 0·263, which indicated a strong effect of the surgical approach to cost. The length of hospital stay was the most important factor, and the hospitalisation cost increased with increasing number of days spent at hospitals. The distribution of average hospitalisation cost of hip fracture patients varied a lot across different provinces, presenting a multicenter, radicalised distribution pattern, which did not match with the local income level. InterpretationThe regional economic and medical development is highly inconsistent, and the hospitalisation cost of hip fracture has become a great burden to many patients' families, especially those living in economically underdeveloped regions with high medical expense. However, the medical insurance now only covers the hospitalisation cost to a limited extent. Thus, we call for further enhancement of the Chinese medical insurance policy, which should be implemented according to the distribution characteristics of hospitalisation cost and local income levels. FundingChinese National Ministry of Science and Technology 973 Project (2014CB542201) and 863 project (SS2015AA020501), the National Natural Science Fund (31571235, 31571236, 31271284).