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

Yong Yang · Xiaowei Man · Stephen Nicholas · Shuo Li · Qian Bai · Lieyu Huang +2 more

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Healthcare Systems and Reforms Healthcare Policy and Management Acute Ischemic Stroke Management

Abstract

OBJECTIVES: This 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. DESIGN: We 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. SETTING: Chinese urban social insurance system. PARTICIPANTS: A 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 MEASURES: The 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. RESULTS: The 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). CONCLUSIONS: Significant 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.

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References

2013Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement 2012Early appraisal of China's huge and complex health-care reforms 2012Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study 2015Consolidating the social health insurance schemes in China: towards an equitable and efficient health system 2005Racial and Ethnic Differences in Utilization of Mental Health Services Among High-Risk Youths 2014Monitoring Progress towards Universal Health Coverage at Country and Global Levels 2013Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement 2014Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil

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