Imbalance in inpatient costs between urban and rural diabetes patients in Jinan, China

Abstract

This study was to describe and compare the expenditures per hospital admission between urban and rural patients with a primary diagnosis of type 2 diabetes with and without complications in an urban tertiary hospital in Jinan, China. This study comprised 880 inpatients hospitalized from 1 January 2006 to 31 August 2008. Inpatient costs were directly collected from hospital accounting system, which comprised the costs of all prescribed drugs, medical procedures, laboratory tests, hotel service, and nursing care during the hospital stay. Generalized linear model (GLM) with log-link and gamma variance functions was used to identify the differences in the total inpatient costs between urban and rural patients after controlling for the potential cost predictors. The adjusted individual inpatient costs per hospitalization were $1680 for urban patients and $1437 for rural patients who had no complications; $1973 and $1687 for those with microvascular diseases; $2045 and $1750 for those with macrovascular diseases; $2208 and $1889 for those with both microvascular and macrovascular diseases (p < 0.05 between urban and rural patients for all the categories). The costs of prescribed drugs accounted for more than two thirds of the total costs in both groups. Urban residence was positively associated with inpatient costs in addition to diabetic complications, insurance, days in the hospital, male gender, and insulin treatment. In conclusion, within the same disease category, rural patients always spent less than the urban patients’ per hospital admission. Large out-of-pocket financing burden, low medical insurance coverage and reimbursement rate, and low income of rural patients can partly attribute to the urban–rural gap in healthcare expenditures.