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

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.

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Estimated annual prevalence, medical service utilization and direct costs of lung cancer in urban China

Cancer Medicine ◽

10.1002/cam4.3845 ◽

2021 ◽

Author(s):

Dawei Zhu ◽

Xuefeng Shi ◽

Stephen Nicholas ◽

Yong Ma ◽

Ping He

Keyword(s):

Lung Cancer ◽

Service Utilization ◽

Medical Service ◽

Direct Costs ◽

Urban China ◽

Medical Service Utilization ◽

Annual Prevalence

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Examining health anxiety among Lynch syndrome carriers

10.32920/ryerson.14655069.v1 ◽

2021 ◽

Author(s):

Jenna J. Albiani

Keyword(s):

Lynch Syndrome ◽

Service Utilization ◽

Medical Service ◽

Qualitative Content Analysis ◽

Health Anxiety ◽

Physical Symptoms ◽

Genetic Mutation ◽

Self Report ◽

Psychological Consequences ◽

Medical Service Utilization

The current research was designed to examine health anxiety among individuals with Lynch syndrome; a genetic predisposition to adult onset cancers. This research had two aims: 1) To examine the severity of health anxiety in Lynch syndrome patients and identify predictors and consequences associated with health anxiety, and 2) To examine the additional impact health anxiety has on parents with Lynch syndrome. Two studies were conducted. In Study I, 209 individuals with Lynch syndrome, selected from a genetic cancer registry, completed self-report measures assessing health anxiety, medical and psychological variables, and medical service utilization. Results indicated that 30% of participants reported clinically significant levels of health anxiety. Regression analyses revealed that younger age, greater depression, anxiety, worry interference and emotional preoccupation coping were predictive of increased health anxiety. Increased health anxiety was associated with greater overall medical service utilization; specifically, visits to gastroenterologists and emergency departments. In Study II, purposive sampling was used to identify parents from Study I who reported the highest and lowest health anxiety. Twenty-one individuals completed semi-structured telephone interviews about their experience of being a parent with Lynch syndrome, their concerns of potentially passing down the genetic mutation to their children, and their perceptions of their children’s health. Qualitative content analysis using a template coding approach was used to examine the differences between parents with high and low health anxiety. Findings revealed that the most prevalent difference was in relation to parent’s perceptions of their personal health. Those with high health anxiety experienced worries that were more extreme, demonstrated a hypervigilance towards physical symptoms, discussed the emotional and psychological consequences of Lynch syndrome as more negative and severe, and had a tendency to engage in more dysfunctional coping strategies. Unexpectedly, with regards to their perceptions of their children, the parents in the high and low health anxiety groups exhibited similar worries. Taken together, the findings from Studies I and II suggest that health anxiety is of clinical significance for individuals with Lynch syndrome. Accurately identifying and treating health anxiety among this population may be one avenue to reduce the distress experienced by Lynch syndrome carriers.

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