Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study (Preprint)

Abstract

BACKGROUND The increasing incidence of inflammatory bowel disease (IBD) has brought heavy cost burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing IBD patients about disease budgets and health care strategies. OBJECTIVE This study evaluated the economic status and medical care access of IBD patients through the CCCF (China Crohn’s and Colitis Foundation) internet platform in China. METHODS Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat platform. Totally 3000 IBD patients consisting of 1922 patients with Crohn’s disease (CD), 973 patients with ulcerative colitis (UC), and 105 patients with undetermined colitis completed the 64-item questionnaires for analysis. Data were collected by the Wenjuanxing survey program on internet. RESULTS The median age of the respondents was 34 years (range 18–73 years). The income of 85.5% of the patients was under ¥10,000 per month. Health medical insurance covered 96.5% of the patients, but only 14.4% of the patients had commercial insurance, which has higher imbursement ratios. During the last 12 months, the outpatient costs for 41.7% of the patients were over ¥20,000, and the inpatient expenses for 30.7% of the patients exceeded ¥50,000. The average reimbursement ratios for most outpatient and inpatient costs were less than 60%. In addition, 61.7% (n=626) of the patients covered biological agents at their own expense without any reimbursement. Approximately half of the respondents (42.7%) had no primary care provider (PCP) (n = 1282), and 52.2% of the patients needed to go to the ER 1-4 times per year because of IBD, lower level of income, higher travel and accommodation costs were significantly associated with ER times More than 50% of the patients were >50 km away from the closest IBD center, and more than 70% of the patients needed >1 hr to get to the closest IBD center. In all, 98.0% (n = 2954) of the patients worried about their financial problems; thus, 79.7% (n = 2392) of the IBD patients sought ways to save money for health care and even delayed their health care or medical treatments. CONCLUSIONS Chinese patients with IBD have enormous financial burdens and difficulties related to health care access, which have increased their economic worries and inevitably influenced their disease management. Advanced measures should be taken to reduce health care spending and improve disease outcomes. CLINICALTRIAL none