Analysis of hospital charges for cerebral infarction stroke inpatients in Beijing, People's Republic of China

• Published in: Health policy (Amsterdam) Vol. 59; no. 3; pp. 243 - 256
• Main Authors: Tu, Feng, Tokunaga, Shoji, Deng, ZhouLu, Nobutomo, Koichi
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.03.2002; Elsevier
• Series: Health Policy
• Subjects: Adult; Aged; Aged, 80 and over; Beijing; Cerebral infarction; Cerebral Infarction - economics; Cerebral Infarction - epidemiology; Cerebral Infarction - physiopathology; Cerebral Infarction - therapy; Charge analysis; China; China - epidemiology; Cost of Illness; Female; Health; Health administration; Health care; Health economics; Health expenditure; Health insurance; Health policy; Health Status Indicators; Hospital Charges - statistics & numerical data; Hospitals; Humans; Inpatient charges; Insurance; Insurance, Hospitalization; Length of Stay - statistics & numerical data; Male; Medically Uninsured; Middle Aged; Policy studies; Treatment Outcome; China; Inpatient charges; Cerebral infarction; Charge analysis; China; Insurance
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/S0168-8510(01)00182-8

Objective: Stroke is a heavy economic burden on the individuals, society and health services in China, where health expenditure is rising rapidly. The purpose of the present study is to examine health services and demographic factors associated with inpatient charges for cerebral infarction in China, focusing on hospital charges of insured and uninsured patients. Methods: The study subjects were 545 patients with a principal diagnosis of cerebral infarction stroke who were discharged from the China–Japan Friendship Hospital from January 1, 1997 through December 31, 1998. Demographic, clinical and administrative data were retrospectively collected from the medical record and financial database. The influence of social and medical factors on total charges was analyzed with stepwise multiple regression model. Results: Of 545 subjects, 429 (79%) were the insured patients and 116 (21%) were the uninsured patients. Length of hospital stay (LOHS) for the insured patients (median, 32 days) was significantly longer ( P<0.001) than that for the uninsured (median, 23 days). The hospital charges per discharge for the insured was significantly higher (geometric mean, 10 407 yuan) ( P<0.0001) than that for the uninsured patients (geometric mean, 5857 yuan). With stepwise multiple regression, factors associated independently with the hospital charge were: longer hospital stay, insurance status, increased number of head magnetic resonance imaging (MRI) and computerized tomography (CT), infection in hospital stay, and more severe condition of stroke. Conclusions: Inpatient charge for cerebral infarction stroke was positively associated with being the insured. The findings suggest an overuse of health care resources in insured patients and limited use of resources by those who are not.