Medical Service Utilization and Direct Medical Cost of Stroke in Urban China.

Dawei Zhu,Xuefeng Shi,Ruoxi Ding,Ping He,Stephen Nicholas,Siyuan Chen,Lieyu Huang,Yong Ma

doi:10.34172/ijhpm.2020.111

Abstract

Background: Understanding the treatment costs of stroke can guide health policies and interventions. However, few studies have analyzed the treatment costs of stroke in China. The aim of this study is to assess stroke-related medical service utilization, direct costs of stroke and associated stroke predictors, and, second, to understand the structure of medical resource use. Methods: This study used a 5% random sample of claim data from China’s Urban Basic Medical Insurance between January 2013 to December 2016. The sampling design assigned a sample weight to each beneficiary. Weighted descriptive analyses, Poisson regression and generalized linear model were used to analyze the medical service utilization, costs and their associations with patient characteristics. Results: In urban China, the annual prevalence of stroke was 730.43 (95% CI = 730.10-730.76) cases per 100 000 people, and nearly 2% of total health expenditures of urban residents was spent on stroke-related medical costs. Weighted average annual total medical cost of stroke was RMB10 637 [95% CI = 10 435-10 840] (US$1682, 95% CI = 1650-1714), with annual out-of-pocket (OOP) cost of RMB3093 [95% CI = 3026-3161] (US$489, 95% CI = 478-500). The average yearly number of stroke-related outpatient visit was 1.67 [SD = 3.39] and inpatient admission was 0.79 [SD = 0.83], with an average cost of RMB440 [SD = 739] (US$70, SD = 117) for outpatients and RMB12 702 [SD = 21 424] (US$2008, SD = 3387) for inpatients. Inpatient costs accounted for 94% (RMB10 034 or US$ 1586) of medical costs, and tertiary hospitals were the main provider of stroke care. Stroke-related medical care utilization and direct costs were associated with gender, age, pathological stroke types and insurance status. Medication costs contributed to 50.6% (RMB5382 or US$ 851) of the average stroke-related medical costs. Conclusion: China’s health system bares a large economic burden from stroke. Specific policies are needed to strengthen the capacity of secondary hospitals, alter the structure of medical resource allocation, and target specific sections of the stroke population.

Highlights

Stroke is the second most common cause of death globally, imposing a heavy financial burden on patients and a country’s health system.[1]
In urban China, the annual prevalence of stroke was 730.43 cases per 100 000 people, with nearly 2% of total health expenditures of urban residents spent on stroke, and the average annual direct medical cost per stroke was RMB10 637 (US$1682), with out-of-pocket (OOP) costs of RMB3093 (US$489) or 29.04% of total stroke costs
Using China’s Urban Employee’s Basic Medical Insurance (UEBMI) and Urban Resident’s Basic Medical Insurance (URBMI) claims data between January 2013 to December 2016, this study aims to estimate the annual prevalence and direct medical cost of stroke in urban China

Summary

Introduction

Stroke is the second most common cause of death globally, imposing a heavy financial burden on patients and a country’s health system.[1] Cost of illness studies reported that the healthcare expenditures spent on strokes is roughly 2%4% of total health expenditures worldwide and accounted for more than 4% of total health expenditures in developed countries.[2,3] The total annual direct costs of stroke have been variously estimated at £4 billion in the United Kingdom,4 €5 billion in France,[5] and US$21 billion in the United States,[2,6] with the estimated average cost of stroke US$19 018 (median US$14 571), ranging from US$468 to US$146 149.7. A study conducted in China estimated the direct medical cost for ischemic stroke was RMB23.7 (US$3.4) billion and for intracerebral hemorrhage RMB13.7 (US$2.0) billion in 2003.11 The average medical cost of per stroke inpatient admission ranged from RMB6773 ($US983) in Sichuan[12] to RMB30 550 (US$4434) in Beijing.[13] These estimates of the treatment costs of stroke have several limitations. The first nationwide study was conducted a decade ago and based on admission of only government-funded general hospitals.[11]

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Discussion

Conclusion