Health care utilization for patients with stroke: a 3-year cross-sectional study of China’s two urban health insurance schemes across four cities
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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.
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Cites
Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., Mensah, G. A., Connor, M., Bennett, D. A., Moran, A. E., Sacco, R. L., Anderson, L., Truelsen, T., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(13)61953-4 · Cited by 3,899 · see citing works
Early appraisal of China's huge and complex health-care reforms
Yip, W. C.-M., Hsiao, W. C., Chen, W., Hu, S., Ma, J., & Maynard, A. (2012) · The Lancet · doi:10.1016/s0140-6736(11)61880-1 · Cited by 1,155 · see citing works
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- Authors
- Yang, Y., Nicholas, S., Li, S., Huang, Z., Chen, X., Ma, Y., & Shi, X.
- Affiliations
- Beijing University of Chinese Medicine (CN)
- Tianjin Normal University (CN)
- Corresponding author
- Shi, Xuefeng
- Venue
- BMC Public Health
- Published
- 2021-03-18
- Volume
- 21
- Issue
- 1
- Pages
- 531-531
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC7977157
- OpenAlex
- W3136740881
- Cited by
- 6
- References
- 2
- Citations by year
- 2026: 2 · 2023: 1 · 2022: 1 · 2021: 2
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Beijing University of Chinese Medicine
- Topics
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- stroke, health care utilization, health care costs, urban resident basic medical insurance, social health insurance, health insurance consolidation, out-of-pocket costs, length of hospital stay, outpatient visits, inpatient visits, health care access disparities, China
- MeSH terms
- Beijing, China, Cities, Cross-Sectional Studies, Health Expenditures, Humans, Insurance, Health, Patient Acceptance of Health Care, Urban Population, Stroke
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