Direct medical costs for patients with schizophrenia: a 4-year cohort study from health insurance claims data in Guangzhou city, Southern China

Abstract

BackgroundSchizophrenia is one of the leading public health issues in psychiatry and imposes a heavy financial burden on the healthcare systems. This study aims to report the direct medical costs and the associated factors for patients with schizophrenia in Guangzhou city, Southern China.MethodsThis was a retrospective 4-year cohort study. Data were obtained from urban health insurance claims databases of Guangzhou city, which contains patients’ sociodemographic characteristics, direct medical costs of inpatient and outpatient care. The study cohort (including all the reimbursement claims submitted for schizophrenia inpatient care during November 2010 and October 2014) was identified using the International Classification of Diseases Tenth version (F20). Their outpatient care information was merged from outpatient claims database. Descriptive analysis and the multivariate regression analysis based on Generalized Estimating Equations model were conducted.ResultsA total of 2971 patients were identified in the baseline. The cohort had a mean age of 50.3 years old, 60.6% were male, and 67.0% received medical treatment in the tertiary hospitals. The average annual length of stay was 254.7 days. The average annual total direct medical costs per patient was 41,972.4 Chinese Yuan (CNY) ($6852.5). The inpatient costs remained as the key component of total medical costs. The Urban Employee Basic Medical Insurance enrollees with schizophrenia had higher average costs for hospitalization (CNY42,375.1) than the Urban Resident Basic Medical Insurance enrollees (CNY40,917.3), and had higher reimbursement rate (85.8% and 61.5%). The non-medication treatment costs accounted for the biggest proportion of inpatient costs for both schemes (55.8% and 64.7%). Regression analysis suggested that insurance type, age, hospital levels, and length of stay were significantly associated with inpatient costs of schizophrenia.ConclusionsThe direct annual medical costs of schizophrenia were high and varied by types of insurance in urban China. The findings of this study provide vital information to understand the burden of schizophrenia in China. Results of this study can help decision-makers assess the financial impact of schizophrenia.

Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China

“…Individual patients who had a stroke were divided into different groups according to factors that impacted their utilisation of inpatient health services. 17 Using ICD-10, ischaemic stroke types were defined by I63, I63.0–5 (cerebral infarction due to thrombosis of precerebral arteries, embolism of precerebral arteries, unspecified occlusion or stenosis of precerebral arteries), I63.8 and I63.9 (other and unspecified cerebral infarction). Based on bed size, location and functional orientation, hospitals in China were divided into primary hospitals, with less than 100 beds, providing basic health services to residents in a community; secondary hospitals, with 100–500 beds, providing comprehensive health services to several communities as well as medical training and regional-based research and tertiary hospitals, with over 500 beds, providing complex healthcare for several districts and undertaking advanced medical education and research.…”

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

“…One explanation is that UEBMI offers a comprehensive coverage while URBMI focused on inpatient support and catastrophic illness for outpatient services. Some basic outpatient services were not covered by URBMI (33), consequently URBMI patients visited hospital less frequently than UEBMI members (30). Our results also showed that UEBMI members had a larger number of outpatient visits than URBMI members and most of the outpatients in our sample were covered by UEBMI (71.1%).…”

“…Since socioeconomic status and education level have been found to be important in uential factors in pre-hospital delay, which will affect the ALOS for ischemic stroke inpatients (28), we speculate that patients covered by UEBMI had higher levels of education and socioeconomic status than URBMI members, as well as paying more attention to their personal health (15). Consequently, UEBMI members sought medical treatment at higher level of hospitals and were more willing to consume additional health services, which were not covered by the health insurance, than URBMI patients (29,30). Second, different therapeutic schedules could be adopted by doctors according to patients' insurance status, and the UEBMI insurance scheme bene t schedule was more generous, as shown in Table 1, and offered a higher reimbursement rate than URBMI (14,31).…”

Disparities in the utilization of ischemic stroke inpatient services in China: the role of urban health insurance

“…Individual stroke inpatients were divided into different groups according to factors that impacted their utilization of inpatient health services (31). Using ICD-10, ischemic stroke types were defined by I63 and i63.0-5 (cerebral infarction due to thrombosis of precerebral arteries, embolism of precerebral…”