Analysis on Medical Expenses of Hypertensive Inpatients in Urban Areas from 2010 to 2013—Evidence from Two Provinces in South of China

Abstract

Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people’s poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID), including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket (OOP) expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients (P>0.05). People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.

Keywords

hypertension / medical insurance / medical expense / economic burden

References

[1] ZhouM, WangH, ZhuJ, et al.. Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272

[2] WangR, YanZ, LiangY, et al.. Prevalence and patterns of chronic disease pairs and multi-morbidity among older Chinese adults living in a rural area. PLoS One, 2015

[3] WangZ, LiX, ChenM. Catastrophic health expenditures and its inequality in elderly households with chronic disease patients in China. Int J Equity Health, 2015, 14(1): 8

[4] National Health and Family Planning Commission of the People’s Republic of China: Planning of chronic disease prevention and control in China (2012–2015). 7415ca4996b3567e5a09e43300.shtml

[5] WHO, Global status report on non-communicable diseases 2014. WHO Press, Geneva, 2014:67.

[6] MohanS, CampbellNR. Hypertension management in Canada: good news, but important challenges remain. CMAJ, 2008, 178(11): 1458-1460

[7] MurrayCJ, LopezAD. Global mortality, disability, and the contribution of risk factors: global burden of disease. Lancet, 1997, 349(9063): 1436-1442

[8] Wolf-MaierK, CoperRS, BanegasJR, et al.. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA, 2003, 289(18): 2363-2369

[9] National Health and Family Planning Commission of the People’s Republic of China. China Health Statistics Yearbook 2015, 2015.

[10] WangJ, ZhangL, WangF, et al.. Prevalence, awareness, treatment, and control of hypertension in China: results from a national survey. Am J Hypertension, 2014, 27(11): 1355-1361

[11] WHO, World Health Statistics 2014. WHO Press, Chicago, 2014:141–151

[12] SiY, ZhouZ, SuM, et al.. Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China. Int J Equity Health, 2017, 16(1): 27

[13] BaiY, ZhaoY, WangG, et al.. Cost-effectiveness of a hypertension control intervention in three community health centers in China. J Prim Care Community Health, 2013

[14] YuB, ZhangX, WangG. Full coverage for hypertension drugs in rural communities in China. Am J Manage Care, 2013

[15] ZhangM, MengY, YangY, et al.. Major inducing factors of hypertensive complications and the interventions required to reduce their prevalence: an epidemiological study of hypertension in a rural population in China. BMC Public Health, 2011, 11: 301

[16] IslamMM, YenL, ValderasJM, et al.. Out-of-pocket expenditure by Australian seniors with chronic disease: the effect of specific diseases and morbidity clusters. BMC Public Health, 2014, 14(1): 1008

[17] CallanderEJ, CorscaddenL, LevesqueJF. Out-of-pocket healthcare expenditure and chronic disease? Do Australians forgo care because of the cost?. Aust J Prim Health, 2016, 23(1): 15-22

[18] YusufF, LeederSR. Can’t escape it: the out-of-pocket cost of health care in Australia. Med J Aust, 2013, 199(7): 475-478

[19] DuttonP. Addressing out of pockethealth costs for consumers: the Coalition’s strategy. Health Voice, 2013, 12: 3-4

[20] ChoiJW, ChoiJW, KimJH, et al.. Association between chronic disease and catastrophic health expenditure in Korea. BMC Health Serv Res, 2015, 15: 26

[21] ParkEC. Health policy for the new government. J Korean Med Assoc, 2012, 55(11): 1040-1042

[22] State Council of the People’s Republic of China.. Opinions on the integration of basic medical insurance system for urban and rural residents, 2016

[23] YipWC, HsiaoWC, ChenW, et al.. Early appraisal of China’s huge and complex health-care reforms. Lancet, 2012, 379: 833-842

[24] TangS, TaoJ, BekedamH. Controlling cost escalation of healthcare: making universal health coverage sustainable in China. BMC Public Health, 2012

[25] LiTZ, WeiH, PanXS, et al.. Morbidity rate of hypertension and its relationship with hyperuricemia in adults. Zhongguo Gonggong Weisheng (Chinese), 2010, 26(3): 273-275

[26] FuSY, LiWM, CaoYM. A 50-year study on the epidemiology of hypertension in Heilongjiang Province of China. Zhonghua Neike Zazhi (Chinese), 2009, 48(5): 375-379

[27] GuptaN, JaniKK, GuptaN. Hypertension: salt restriction, sodium homeostasis, and other ions. Indian J Med Sci, 2011, 65(3): 121-132

[28] CaiL, ShuZK, DongJ, et al.. The economic burden of hypertension in rural south-west China. Trop Med bit Health, 2012, 17: 1544-1551

[29] YiH, YanL, YangX, et al.. Global budget payment system helps to reduce outpatient medical expenditure of hypertension in China. Springer Plus, 2016, 5(1): 1877

[30] WangJ, ChenL, YeT, et al.. Financial protection effects of modification of China’s New Cooperative Medical Scheme on rural households with chronic diseases. BMC Health Serv Res, 2014, 14(1): 305

[31] General Office of the State Council of the People’s Republic of China. Opinions on comprehensive reform of county public hospitals. 2012. https://doi.org/www.gov.cn/zhuanti/2015-0613/content_2879036.htm

[32] RongmeiS, GuowuD. Analyzing the Expenditures of Rural Inpatients who Joined in New Rural Cooperative Medical System in Hospitals in Different Grades. Chin Health Serv Manag, 2010, 27(3): 191-192

[33] ChengB, RenG, WangZL, et al.. Trend Analysis of the Average Hospitalization Expenses in NCMS Contracted Health Facilities. Zhongguo Weisheng Jingji (Chinese), 2009, 28(7): 31-33

[34] LiuMH, WuQQ. Study on the Shortage of Essential Drugs in China. Zhongguo Yaofang (Chinese), 2012, 23(8): 673-674

[35] National HealthFamily Planning Commission of the People’s Republic of China.. Analysis report of the Fifth National Health Service Survey, 2013

[36] YangF, YuBR. Analysis on annual change of medical expenses for hypertensive inpatients with different types of health insurance. Zhongguo Weisheng Ziyuan (Chinese), 2012, 15(5): 406-408

[37] XiongY, XieJL, ZouLA. Analysis on Hospitalization Costs among PCI Operation Patients with Coronary Heart Disease under Different Medical Insurances. Zhongguo Weisheng Jingji (Chinese), 2015, 34(9): 31-34

[38] LiM, CuiL. Moral Hazard and Expenditure Control in Social Health Insurance. Popul Econ, 2007, 4: 76-80

[39] XuY, GaoJ, ZhouZ, et al.. Measurement and explanation of socioeconomic inequality in catastrophic health care expenditure: evidence from the rural areas of Shaanxi Province. BMC Health Service Res, 2015, 15(1): 256