Costs of hospitalization for stroke from two urban health insurance claims data in Guangzhou City, southern China

Abstract

Background Stroke remains a major global health problem. In China, stroke was the leading cause of death and imposed a large impact on the healthcare system. This study aimed to examine the hospitalization costs by five stroke types and the associated factors for inpatient costs of stroke in Guangzhou City, Southern China. Methods This was a prevalence-based, cross-sectional study. Data were obtained from urban health insurance claims database of Guangzhou city. Samples including all the reimbursement claims submitted for inpatient care with the primary diagnosis of stroke from 2006 to 2013 were identified using the International Classification of Diseases codes. Descriptive analysis and multivariate regression analysis based on the Extended Estimating Equations model were performed. Results A total of 114,872 hospitalizations for five stroke types were identified. The average age was 71.7 years old, 54.2% were male and 60.1% received medical treatment in the tertiary hospitals, and 92.3% were covered by the urban employee-based medical insurance. The average length of stay was 26.7 days. Among all the hospitalizations (average cost: Chinese Yuan (CNY) 20,203.1 = $3212.1), the average costs of ischaemic stroke (IS), subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH), transient ischaemic attack (TIA), and other strokes were CNY 17,730.5, CNY 62,494.2, CNY 38,757.6, CNY 10,365.3 and CNY 18,920.6, respectively. Medication costs accounted for 42.9, 43.0 and 40.4% of the total inpatient costs among patients with IS, ICH and TIA, respectively, whereas for patients with SAH, the biggest proportion of total inpatient costs was from non-medication treatment costs (57.6%). Factors significantly associated with costs were stroke types, insurance types, age, comorbidities, severity of disease, length of stay and hospital levels. SAH was linked with the highest inpatient costs, followed by ICH, IS, other strokes and TIA. Conclusions The costs of hospitalization for stroke were high and differed substantially by types of stroke. These findings could provide economic evidence for evaluating the cost-effectiveness of interventions for the treatment of different stroke types as well as useful information for healthcare policy in China.

Health care utilization for patients with stroke: a 3-year cross-sectional study of China’s two urban health insurance schemes across four cities

“…This is a 3-year cross-sectional study designed to evaluate the health service utilization of stroke patients according to the different cities’ health insurance schemes. Between 2014 and 2016, we obtained all related information on patients whose primary diagnosis was stroke according to ICD-10 (ischemic stroke (I63), hemorrhagic stroke (I60, I61, I62, G45) and other types of stroke (I64, I67-I69, 7, 10) [ 19 ]. The final sample included 69,054 patients and 203,697 admissions, including 52,412 patients who were insured by UEBMI and 16,642 patients who were covered by URBMI.…”

“…Depending on the coverage, benefit schedule and reimbursements, a patient’s health insurance scheme impacted the financial burden of stroke on families [ 19 ]. Insurance scheme provided a safety net from financial loss, depending on the scope and incentives or disincentives for patients to consume health services [ 20 ].…”

“…Previous studies have identified that patients covered by UEBMI had higher medical costs than those covered by URBMI [ 7 , 21 ]. Using the urban health insurance claims database of Guangzhou city, Zhang et al [ 19 ] found that UEBMI inpatients had higher hospital expenses than URBMI inpatients suffering four different subtypes of stroke. Conducting a cross-sectional study, Zhu et al [ 7 ] also found that UEBMI patients had higher medical costs than URBMI patients.…”

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

“…And in China, the newest evidence showed that nearly 2% of total health expenditures of urban residents were spent on stroke-related medical costs [ 3 ]. Previous studies have assessed medical costs for stroke patients in some specific cities in China: In Guangzhou, the average medical costs was $3212.1 from 2006 to 2013 [ 4 ], and it was calculated as $3052.7 in Beijing city in 2012 [ 5 ]. It seemed that geographic variation in stroke patients’ medical costs widely existed in China.…”

Geographic Variations in Stroke Inpatient Healthcare Utilization and Hospital Expenditure Equity in China

“…Covering more than 95% of the residents in urban China during the 2013-2016 period, the two schemes covered roughly 750 million, or 54%, of the total Chinese population [12].The basic differences between UEBMI and URBMI are set out in Table 1.UEBMI is funded both by employers (2% of wages) and employees (6% of annual wages) [13], while the revenue for the URBMI is from individual premium contributions and subsides from central and local government.As shown in Table 1, UEBMIprovides better nancial protection and offers a more comprehensive coverage than URBMI, which focuses on inpatient services, catastrophic illness insurance, but withlimited coverage of basic outpatient services [14]. Patients with UEBMI usually utilize more health services and have higher expense than those with URBMI [15].…”