Yong Yang1, Stephen Nicholas2,3,4,5, Shuo Li1, Zhengwei Huang1, Xiaoping Chen1, Yong Ma6, Xuefeng Shi7,8. 1. School of Management, Beijing University of Chinese Medicine, Beijing, China. 2. Australian National Institute of Management and Commerce, Sydney, New South Wales, Australia. 3. Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China. 4. School of Economics and School of Management, Tianjin Normal University, Tianjin, China. 5. Newcastle Business School, University of Newcastle, Newcastle, Callaghan, Australia. 6. China Health Insurance Research Association, Beijing, China. 7. School of Management, Beijing University of Chinese Medicine, Beijing, China. shixuefeng981206@163.com. 8. National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China. shixuefeng981206@163.com.
Abstract
BACKGROUND: Stroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in stroke patients' health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China. METHODS: A 5% random sample from the 2014-2016 China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data. RESULTS: We found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMI patients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMI patients had significantly higher outpatient medical costs (RMB356.9) than URBMI patients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: - 0.672, - 0.649) fewer outpatient visits, 13.0% (95% CI: - 0.144, - 0.115) fewer inpatient visits, and 34.2% (95% CI: - 0.366, - 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference. CONCLUSIONS: Significant city-specific differences in stroke patients' healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of stroke patient access to health care.
BACKGROUND:Stroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in strokepatients' health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China. METHODS: A 5% random sample from the 2014-2016 China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data. RESULTS: We found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMIpatients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMIpatients had significantly higher outpatient medical costs (RMB356.9) than URBMIpatients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: - 0.672, - 0.649) fewer outpatient visits, 13.0% (95% CI: - 0.144, - 0.115) fewer inpatient visits, and 34.2% (95% CI: - 0.366, - 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference. CONCLUSIONS: Significant city-specific differences in strokepatients' healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of strokepatient access to health care.
Entities:
Keywords:
Health insurance; Healthcare utilization; Medical costs; Stroke