Had the Individual Medical Burden of Basic Health Insurance Participants Really Been Alleviated in 2009-2012?

Medical service utilisation and direct medical cost of depression: a cross-sectional analysis of urban medical claims data from China

OBJECTIVES

Depression is becoming a growing cause of disability, suicides and disease burden. It incurred substantial costs to societies all over the world. Estimating the medical costs of depression will provide implications for related policies and interventions. However, there is scarce of evidence on the economic costs of depression in China. The aim of this study is to assess depression-related medical service utilisation, the direct medical costs of depression and potential associated factors.

SETTINGS

This study used data that comprised 5% random sample of claims data from China's Urban Basic Medical Insurance between January 2013 and December 2016. Beneficiaries' demographic information, diagnoses and cost of outpatient and inpatient services were recorded in the data set.

PARTICIPANTS

26 123 patients with depression were identified as the study population in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The information on health service utilisation and cost was extracted based on the condition that depression was claimed as the index disease.

RESULTS

From 2013 to 2016, weighted average annual total medical cost of depression in urban China was RMB2706.92, and the annual out-of-pocket cost was RMB786.4. The annual total medical cost of depression among urban residents in China was estimated to be 4.4 billion RMB (95% CI 4.15 to 4.67) (US$ 0.70, 95% CI 0.66 to 0.74). Nearly 65% of medical costs (RMB 1795.7 or US$ 285.0) were accounted by inpatient expenditure, and tertiary hospitals were the main provider of depression treatment. Depression-related medical care utilisation and direct costs were associated with gender, age, insurance status, severity of depression and diagnosis. Medication costs and medical service contributed to 41.7% and 56.6% of the average depression-related medical costs.

CONCLUSION

Depression poses a considerable burden on both the health system and the individual in urban China. Specific policies to strengthen the mental health resources in primary and secondary hospitals are in urgent need, and effective treatment strategies are important to prevent a progression and recurrence of depression, as well as an increase in medical cost.

Financing Adolescent Health in China: How Much, Who Pays, and Where It Goes

PURPOSE

Adolescent health has been gaining increasing attention in the Sustainable Development Goals era. Data on adolescent health financing are essential for evidence-based policy planning and evaluation. Little is known on national expenditure on adolescent health in China. To inform decision-making on national strategies of adolescent health and development, this study estimated expenditure on adolescent health-care utilization in China and identified funding sources and their allocation among different health functions.

METHODS

We constructed and implemented an institutional survey and collected primary financial data from health institutions in the nine selected administrative provinces in 2014. We used the collected data to generate estimate of proportion of health spending on adolescent health and its breakdowns by health-care functions, health-care financing schemes, and diseases based on primary diagnosis. We applied the proportion estimates to the 2014 national-level health expenditure data and estimated national-level estimates of spending on adolescent health and breakdowns in aforementioned areas.

RESULTS

Spending on adolescents health in 2014 amounted to CNY82.1 billion (USD 13.4 billion) or 2.6% of the total health expenditures in the year. Per adolescent health expenditures was CNY525 (USD 85.5), less than per capita health spending (CNY2349, USD382.4). National spending on adolescent health was 73.1% on curative care and 10.3% on preventive care. Out-of-pocket spending is the major source of adolescent health financing, contributing to 57.9% of total spending on adolescent health. Spending on respiratory, digestive, injury and poisoning, genitourinary diseases, and neoplasms accounted for 59.8% of curative care expenditures on adolescents.

CONCLUSIONS

Current financing mechanism on adolescent health stressed on curative care and imposed a large portion of financial burden on households. Future investment on adolescent health shall focus more on preventive care. Financing schemes shall be adjusted so as to reduce household out-of-pocket spending on medical care used by adolescents.

Impact of universal medical insurance system on the accessibility of medical service supply and affordability of patients in China

Background

China’s universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China.

Methods

Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS.

Results

China’s UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for inpatients of Urban Employee’s Basic Medical Insurance was the lowest. For the low-income patients, a single hospitalization at a tertiary hospital can lead to catastrophic payments. It is needless to say what the economic burden could be if patients required multiple hospitalizations within a year. UMIS beneficiaries showed the intention of growth to seek hospitalization services in tertiary hospitals.

Conclusions

Introduction of the UMIS contributed to an increase in available medical services and the use thereof, and a decrease in fatality rate. The affordability of UMIS beneficiaries for medical expenses was successfully ameliorated. The differences in patients’ affordability are mainly manifested in different medical insurance schemes and different seeking-care choices. The ability of the poor patients covered by UMIS to resist catastrophic medical payments is still relatively weak. Therefore, the current UMIS should reform the insurance payment model to promote the integration of medical services and the formation of a tiered treatment system. UMIS also should establish supplementary medical insurance packages for the poor.