An equity evaluation in stroke inpatients in regard to medical costs in China: a nationwide study

Abstract

Background Stroke has always been a severe disease and imposed heavy financial burden on the health system. Equity in patients in regard to healthcare utilization and medical costs are recognized as a significant factor influencing medical quality and health system responsiveness. The aim of this study is to understand the equity in stroke patients concerning medical costs and healthcare utilization, as well as identify potential factors contributing to geographic variation in stroke patients’ healthcare utilization and costs. Methods Covering 31 provinces in mainland China, our main data were a 5% random sample of stroke claims from Urban Employees Basic Medical Insurance (UEBMI) and Urban Residents Basic Medical Insurance (URBMI) from 2013 to 2016. The Theil index was employed to evaluate the equity in stroke patients in regard to healthcare utilization and medical costs, and the random-effect panel model was used to explore the impact of province-level factors (health resource factors, enabling factors, and economic factors) on medical costs and health care utilization. Results Stroke patients’ healthcare utilization and medical costs showed significant differences both within and between regions. The UEBMI scheme had an overall lower Theil index value than the URBMI scheme. The intra-region Theil index value was higher than the inter-region Theil index, with the Theil index highest within eastern China, China’s richest and most developed region. Health resource factors and enabling factors (represented by reimbursement rate and education attainment years) were identified significantly associated with medical costs (P < 0.05), but have no impact on average length of stay. Conclusions China’s fragmented urban health insurance schemes require further reform to ensure better equity in healthcare utilization and medical costs for stroke patients. Improving education attainment, offering equal access to healthcare, allocating health resources reasonably and balancing health services prices in different regions also count.

Experience of financial toxicity and coping strategies in young and middle-aged patients with stroke: a qualitative study

“…Several participants expressed the desire for government intervention to expand health insurance coverage. Yang highlighted substantial disparities in healthcare utilization and medical expenditures among stroke patients both within and across regions in China [ 38 ]. Given this situation, the government in China needs to better integrate the national health insurance system, improve its overall structure, broaden health insurance coverage, and ensure equitable welfare and financial protection for patients with stroke across diverse regions.…”

The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China

“…Following the DIP reform, the profitability of hospital receipts from medical insurance payments hinges on the variance between actual medical expenditures and the subsequent post-treatment prices during the year-end settlement. As UEBMI fund in China is funded by employees who pay higher medical insurance premiums compared to those paid by unemployed individuals, farmers, and others contributing to the URRBMI fund [ 37 , 38 ]. UEBMI is endowed with a more generous budget, resulting in higher post-treatment prices for UEBMI inpatients with similar conditions compared to URRBMI inpatients.…”

Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City

“…At first, the UEBMI scheme provided more generous benefit packages, higher reimbursement rates and wider service coverage ( 16 ), which could induce UEBMI patients to seek for more comprehensive health services and thus incurred higher direct medical costs and lower OOP expenses. Second, the UEBMI enrollees often had a stable source of income and better accessibility to health services ( 59 ), while the URBMI enrollees were usually the unemployed, students and children with poorer financial situations ( 61 ). As a result, the URBMI patients with lower income could be more conservative when using medical services and drugs ( 62 ), which might lead to lower spending.…”