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

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.

Use of Traditional Chinese Medicine and Its Impact on Medical Cost among Urban Ischemic Stroke Inpatients in China: A National Cross-Sectional Study

“…From the supply side, the drug markup policy and bonus system, which rewarded physicians based on the monetary values of drugs they prescribed, encouraged physicians to overprescribe drugs [46]. e zero-markup policy for conventional drugs, which was introduced into TCM hospitals from 2012, only reduced conventional drug prices marginally, including the cost of stroke-related drugs, by 2015 [6]. Since Chinese herbal medication was omitted from the zero-markup policy, partly to promote TCM medication use, we suspect that physicians might continue to overprescribe Chinese herbal medicine to pursue their own monetary rewards.…”

“…Stroke has been the leading cause of both death and DALYs in China, with an estimated 1.1 million stroke-related deaths in 2013 or about 15% of the global total of 6 million stroke deaths [4,5]. Among various types of stroke, ischemic was the main subtype in China [6]. A recent study revealed that the weighted average 2013-2016 annual total medical cost of stroke was RMB10637 (USD1707.82), with inpatient costs accounting for 94% (RMB10034 or USD1586) of total stoke medical costs, with medication costs accounting for 50.6% of average stroke-related medical costs [6].…”

“…Among various types of stroke, ischemic was the main subtype in China [6]. A recent study revealed that the weighted average 2013-2016 annual total medical cost of stroke was RMB10637 (USD1707.82), with inpatient costs accounting for 94% (RMB10034 or USD1586) of total stoke medical costs, with medication costs accounting for 50.6% of average stroke-related medical costs [6]. While Chinese stroke patients mainly receive conventional modern medicine in their treatment, it has been claimed that conventional medicine fails to some degree to optimally treat or reduce costs of stroke [7][8][9].…”

Economic burden of comorbid chronic conditions among survivors of stroke in China: 10-year longitudinal study

“…Based on prior studies, several covariates were included in the present study [11][12][13]. They include demographic and socioeconomic status covariates such as age (< 55 or ≥ 55 years), gender (male or female), marital status (single, married, divorced/widowed/ separated, or refuse to answer), educational attainment (illiterate/primary school, junior school, high school or above), household income per capita (lower, middle or upper tertile), employment (employed or not), health insurance (Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, New Rural Cooperative Medical Insurance, commercial and other insurance, or none of above).…”

Will the zero-margin drug policy reduce the economic burden of stroke patients in China?

“…China already accounts for one-third of the world's stroke deaths, and stroke has risen from third place in 1990 to first place in 2017 on the impact of disability-adjusted life years [ 11 ]. At present, the average annual medical expense of stroke patients in China urban areas is 10 637 Chinese Yuan (CNY, 1 CNY ~ 0.1511 US$ in 2018), of which the drug cost accounts for more than 50% [ 12 ].…”