scholarly journals Comparison of health service use and costs in stroke with and without comorbidities: a cross-sectional analysis using China urban medical claims data

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e037032
Author(s):  
Ruoxi Ding ◽  
Dawei Zhu ◽  
Yong Ma ◽  
Xuefeng Shi ◽  
Ping He
Keyword(s):  
Health Service ◽  
Claims Data ◽  
Medical Insurance ◽  
Service Planning ◽  
Urban China ◽  
Health Service Utilisation ◽  
Secondary Outcome ◽  
Service Utilisation ◽  
Basic Medical Insurance ◽  
Basic Medical

ObjectivesStroke is the leading cause of death and disability in China, but there is scare of evidence on whether and to what extent comorbidity affects the stroke-related costs in health system. We examined the association between comorbidity and stroke-related health service utilisation and costs in urban China.SettingsThe data used in this study were extracted by a 5% random sampling from claims data of China Urban Employees’ Basic Medical Insurance and Urban Residents’ Basic Medical Insurance from 2013 to 2016, which covered more than 93% of residents in urban China. The data included 89 cities and contained beneficiaries’ demographic information, medical diagnoses and expenditures of outpatient and inpatients services.Participants382 906 patients with stroke were identified as the study population in this study.Primary and secondary outcome measuresThe information on health service utilisation and cost was extracted based on the condition that stroke was claimed as the index disease.ResultsAmong 382 906 patients with stroke, 41.0% had a comorbidity. The estimated number of annual outpatient visits among patients with 0, 1, 2 and 3 or more comorbidities were 1.97, 2.30, 2.34 and 2.37, respectively. The annual outpatient expenditure increased from 762.4 (95% CI 746.9 to 777.8) RMB among patients without any comorbidities to 1156.4 (1132.7 to 1180.2) RMB among patients with three or more comorbidities. The increased utilisation and costs among patients with comorbidity were also observed for inpatient services. Stroke-related services utilisation and costs were significantly increased among patients who comorbid conditions like hypertension or chronic pulmonary diseases.ConclusionComorbidity among patients with stroke was associated with increased healthcare utilisation and cost. It poses an extra substantial healthcare burden in China. Our study provides information for both clinical management and health service planning and financing for patients with stroke.

scholarly journals The Effect of Urban Basic Medical Insurance on Health Service Utilisation in Shaanxi Province, China: A Comparison of Two Schemes

PLoS ONE ◽  
2014 ◽  
Vol 9 (4) ◽  
pp. e94909 ◽  
Author(s):  
Zhongliang Zhou ◽  
Zhiying Zhou ◽  
Jianmin Gao ◽  
Xiaowei Yang ◽  
Ju'e Yan ◽  
...  
Keyword(s):  
Health Service ◽  
Medical Insurance ◽  
Health Service Utilisation ◽  
Shaanxi Province ◽  
Service Utilisation ◽  
Basic Medical Insurance ◽  
Basic Medical

scholarly journals Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City

2019 ◽  
Vol 16 (15) ◽  
pp. 2781
Author(s):  
Hui Zhang ◽  
Donglan Zhang ◽  
Yujie Yin ◽  
Chao Zhang ◽  
Yixiang Huang
Keyword(s):  
Claims Data ◽  
Average Length ◽  
Medical Insurance ◽  
Urban China ◽  
Health Priorities ◽  
Insurance Scheme ◽  
Basic Medical Insurance ◽  
Dementia Patients ◽  
Hospitalization Costs ◽  
Basic Medical

Background: Dementia is one of the public health priorities in China. This study aimed to examine the hospitalization costs of patients with dementia and analyzed the factors associated with their inpatient costs. Methods: This was a prevalence-based, observational study using claims data derived from two urban insurance schemes during the period from 2008 through 2013 in Guangzhou. The extended estimating equations model was performed to identify the main drivers of total inpatient costs. Results: We identified 5747 dementia patients with an average age of 77.4. The average length of stay (LOS) was 24.2 days. The average hospitalization costs per inpatient was Chinese Yuan (CNY) 9169.0 (CNY 9169.0 = US$1479.8 in 2013). The mean inpatient costs for dementia patients with the Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY 9425.0 = US$1521.1) were higher than those for patients with the Urban Resident-based Basic Medical Insurance scheme (CNY 7420.5 = US$1197.6) (p < 0.001). Having UEBMI coverage, dementia subtypes, having hypertension, being admitted in larger hospitals, and longer LOS were significantly associated with hospitalization costs of dementia. Conclusions: The costs of hospitalization for dementia were high and differed by types of insurance schemes. Dementia was associated with substantial hospitalization costs, mainly driven by insurance type and long LOS. These findings provided economic evidence for evaluating the burden of dementia in China.

scholarly journals Outpatient Visits among Older Adults Living Alone in China: Does Health Insurance and City of Residence Matter?

2020 ◽  
Vol 17 (12) ◽  
pp. 4256
Author(s):  
Jianyun Wang ◽  
Yaolin Pei ◽  
Renyao Zhong ◽  
Bei Wu
Keyword(s):  
Older Adults ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Health Resources ◽  
Medical Insurance ◽  
Urban China ◽  
Living Alone ◽  
Basic Medical Insurance ◽  
Outpatient Visits ◽  
Basic Medical

This study aimed to examine the association between health insurance, city of residence, and outpatient visits among older adults living alone in China. A sample of 3173 individuals was derived from “Survey on Older Adults Aged 70 and Above Living Alone in Urban China” in five different cities. Logistic regression models indicated that older adults living alone who had urban employee basic medical insurance, urban resident basic medical insurance, and public medical insurance were more likely to have outpatient visits than those without any health insurance. After controlling the number of chronic diseases, only those with public medical insurance were more likely to have outpatient visits than uninsured older adults. Additionally, older adults who resided in Shanghai and Guangzhou were more likely to have outpatient visits than those in Chengdu, whereas older adults who were in Dalian and Hohhot were less likely to have outpatient visits. To improve the equity of outpatient visits among older adults living alone in China, policy efforts should be made to reduce fragmentation of different health insurance plans, expand the health insurance coverage for older adults, provide programs that consider the needs of this special group of older adults, and reduce the inequality in health resources and health insurance policies across cities.

scholarly journals Incidence and cost of hemolytic uremic syndrome in urban China: a national population-based analysis

2021 ◽  
Author(s):  
Jingnan Feng ◽  
Ke Xu ◽  
Xinmiao Shi ◽  
Lu Xu ◽  
Lili Liu ◽  
...  
Keyword(s):  
Average Cost ◽  
Medical Insurance ◽  
Developed Countries ◽  
Population Based ◽  
Incidence Rates ◽  
Urban China ◽  
Basic Medical Insurance ◽  
Laboratory Facilities ◽  
Uremic Syndrome ◽  
Basic Medical

Abstract Background: HUS is a severe syndrome that imposes a substantial burden on patients and their families, furthermore, it’s the leading cause of acute kidney failure in children. However, data on the epidemiology and disease burden of HUS are limited in Asia, including in China. We aimed to estimate the incidence and cost of HUS in China.Methods: Data on HUS from 2012 to 2016 were extracted from the databases of the Urban Employee Basic Medical Insurance (UEBMI) and the Urban Resident Basic Medical Insurance (URBMI). All cases were identified by the ICD code and Chinese diagnostic terms. The national incidence rates in 2016 were estimated and stratified by sex, age and season; the associated medical costs were also calculated. Results: The crude incidence was 0.66 per 100,000 person-years (95% CI: 0.57 to 1.06), and the standardized incidence was 0.57 (0.19 to 1.18). The highest incidence was observed in patients younger than 1 year old (5.08,95% CI: 0.23 to24.87). Meanwhile, the incidence was 0.38 per 100,000 person-years (95% CI: 0.13 to 0.75) in patients younger than 5 years old, and 0.29 per 100,000 person-years (95% CI: 0.09 to 0.57) in patients younger than 18 years old. The season with the highest incidence was autumn, followed by winter. The average cost was 1.75 thousand US dollars per patient, which was higher than the national average cost for all inpatients in the same period. Conclusions: The incidence of HUS in our study was lower than those in the most developed countries, and with different age and season distribution in incidence, which may suggest that the cause of HUS in China may be different from that elsewhere. Due to insufficient knowledge of physicians and lacking laboratory facilities required for an accurate diagnosis, the incidence rate of HUS may be underestimated. In view of the healthcare economic burden of HUS, further analyses and supports are needed in the future.

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

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040437 ◽  
Author(s):  
Yong Yang ◽  
Xiaowei Man ◽  
Stephen Nicholas ◽  
Shuo Li ◽  
Qian Bai ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Outcome Measures ◽  
Medical Insurance ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Research Association ◽  
Insurance System ◽  
Basic Medical Insurance ◽  
Basic Medical

ObjectivesThis study investigates the disparities in the utilisation of patient health services for patients who had a stroke covered by different urban basic health insurance schemes in China.DesignWe conducted descriptive analysis based on a 5% random sample from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) in 2015, supplied by the China Health Insurance Research Association.SettingChinese urban social insurance system.ParticipantsA total of 56 485 patients who had a stroke were identified, including 36 487 UEBMI patients and 19 998 URBMI patients.Primary and secondary outcome measuresThe primary outcome measures include annual number of hospitalisations, average length of stay (ALOS) and average hospitalisation cost. Out-of-pocket (OOP) cost is the secondary outcome measure.ResultsThe annual mean number of hospitalisations of UEBMI patients was 1.21 and 1.15 for URBMI patients. The ALOS was significantly longer for UEBMI than for URBMI patients (13.93 vs 10.82, p<0.001). Hospital costs were significantly higher for UEBMI than for URBMI patients (US$1724.02 vs US$986.59 (p<0.001), while the OOP costs were significantly higher for URBMI than for UEBMI patients (US$423.17 vs US$407.81 (p<0.001). Patients with UEBMI had higher reimbursement rate than URBMI patients (79.41% vs 66.92%, p<0.001) and a lower self-paid ratio than URBMI patients (23.65% vs 42.89%, p<0.001).ConclusionsSignificant disparities were found in the utilisation of hospital services between UEBMI and URBMI patients. Our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gaps in China’s health insurance schemes.

scholarly journals Medical expenditure for patients with hemophilia in urban China: data from medical insurance information system from 2013 to 2015

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Guang-wen Gong ◽  
Ying-chun Chen ◽  
Peng-qian Fang ◽  
Rui Min
Keyword(s):  
Rare Disease ◽  
Medical Insurance ◽  
Urban China ◽  
Medical Expenditure ◽  
Basic Medical Insurance ◽  
Insurance Reimbursement ◽  
Quantile Regression Analysis ◽  
Kolmogorov Smirnov ◽  
Hospital Days ◽  
Basic Medical

Abstract Background Hemophilia, a high-cost disease, is the only rare disease covered by basic medical insurance in all province of China. However, very few studies have estimated the medical expenditure of patients with this rare disease Therefore, this study is aimed at evaluating the medical expenditure of patients with hemophilia and identifying its determinants. Methods The study population included 450 patients with hemophilia who were extracted from the national insurance database between 2014 and 2016. An independent-sample Kolmogorov–Smirnov test was performed to compare the medical expenditure of patients with hemophilia covered under urban employee basic medical insurance (UEBMI) and urban residence basic medical insurance (URBMI). Quantile regression analysis was conducted to explore the factors that affect the medical expenditure of patients with hemophilia. Results The total annual medical expenditure of patients with hemophilia in 2013, 2014, and 2015 had median of ¥7167 (US$ 1156), ¥3522 (US$ 577), and ¥4197 (US$ 677), respectively. The median medical expenditures of patients with hemophilia covered by UEBMI were ¥10,991 (US$ 1773), ¥2301 (US$ 377) and ¥8074 (US$ 1302), those of patients covered by URBMI were ¥4000 (US$ 645), ¥5717 (US$ 937) and ¥3141 (US$ 507) from 2013 to 2015. The differences in the medical expenditure of patients with hemophilia between UEBMI and URBMI from 2013 to 2015 were statistically significant. The number of admissions and the number of hospital days were statistically significant and positive for all quantiles. The types of medical service were statistically significant and negative for 50th quantile, and the reimbursement ratio was statistically significant and positive for 50th and 75th quantiles. (p < 0.05). Conclusion The medical expenditure of patients with hemophilia was lower than that of patients with other common rare diseases that were not included in the scope of basic medical insurance reimbursement. It was also observed that the medical expenditure was mainly influenced by the severity of disease, and partly affected by the reimbursement rate.

Incidence and prevalence of amyotrophic lateral sclerosis in urban China: a national population-based study

2020 ◽  
Vol 91 (5) ◽  
pp. 520-525 ◽  
Author(s):  
Lu Xu ◽  
Lu Chen ◽  
Shengfeng Wang ◽  
Jingnan Feng ◽  
Lili Liu ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Age At Onset ◽  
Mainland China ◽  
Medical Insurance ◽  
Developed Countries ◽  
Urban China ◽  
Pathophysiological Mechanism ◽  
Basic Medical Insurance ◽  
Lateral Sclerosis ◽  
Basic Medical

ObjectiveAmyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disease and information on disease burden of ALS in mainland China was limited. We aimed to estimate the prevalence and incidence of ALS in China.MethodsWe used 2012–2016 data from China’s Urban Employee Basic Medical Insurance and Urban Residence Basic Medical Insurance, covering approximately 0.43 billion individuals. ALS cases were identified by the primary diagnosis (International Classification of Diseases code or text of diagnosis) in the insurance database.ResultsThe crude prevalence and incidence in 2016 were 2.91 per 100 000 person-years (95% CI 2.31 to 3.58) and 1.65 (95% CI 1.33 to 2.01), respectively. The standardised prevalence and incidence based on 2010 Chinese census data were 2.97 (95% CI 2.91 to 3.03) and 1.62 (95% CI 1.58 to 1.67), respectively. The annual prevalence between 2013 and 2016 remained relatively constant, ranging from 2.91 (95% CI 2.31 to 3.58) in 2016 to 3.29 (95% CI 2.51 to 4.17) in 2014 (linear regression: β=−0.129, p=0.104). Both rates peaked in the group aged 75–79 years.ConclusionsThe prevalence and incidence of ALS in mainland China were lower than those in developed countries, and maintained a relatively stable trend. The age at onset and age at diagnosis for ALS patients were younger than those in developed countries. Further research is expected to clarify the potential pathophysiological mechanism of ALS.

Sign in / Sign up

Export Citation Format

Share Document