Analysis of hospitalization expenditures and influencing factors for inpatients with coronary heart disease in a tier-3 hospital in Xi'an, China: A retrospective study

Hospitalization expenses of coronary heart disease inpatients in China: evidence from two hospitals in Ningxia Hui autonomous region

Aim

The increasing morbidity from coronary health disease (CHD) has imposed a significant social and economic burden in China. We analyzed the factors affecting hospitalization expenses of CHD patients.

Design

From 2012 to 2018, data on 16,726 CHD patients were collected from the hospital information system in Ningxia Hui Autonomous Region.

Methods

A multiple ordered logistic regression model was used to analyze the factors affecting hospitalization expenses.

Results

The average hospitalization expense was RMB30998.26 ± 29890.03. Hospital materials expenses accounted for roughly 60% of total hospitalization costs. The older adult, patients who were male, in critical health status, with longer hospital stays, unemployed, using antibiotics and undergoing an operation without incision had significantly raised hospital expenses, while those with fewer complications, no operations and self-paying for health care had reduced hospitalization costs (p < 0.05). The length of hospital stay played a partial mediator role (p < 0.05).

Public contribution

Controlling the increase of medical materials costs and preventing over-consumption of hospital services by insured patients are recommended.

The economic burden of coronary heart disease in mainland China

OBJECTIVES

The aim of this study was to systematically evaluate the current economic burden of coronary heart disease (CHD) in mainland China and provide a reference for the formulation of policies to reduce the economic burden of CHD.

STUDY DESIGN

A systematic literature review was conducted of empirical studies on the economic burden of CHD over the past 20 years.

METHODS

PubMed, Web of Science, Embase, China Knowledge Resource Integrated Database and the WANFANG database were comprehensively searched for relevant articles published between 1 January 2000 and 22 December 2021. Content analysis was used to extract the data, and Stata 17.0 software was used for analysis. The median values were used to describe trends.

RESULTS

A total of 35 studies were included in this review. The annual median per-capita hospitalisation expense and the average expense per hospitalisation were $3544.40 ($891.64-$18,371.46) and $5407.34 ($1139.93-$8277.55), respectively. The median ratio on medical consumables expenses, drug expenses, medical examination expenses and treatment expenses were 41.59% (12.40%-63.73%), 26.90% (7.30%-60.00%), 9.45% (1.65%-33.40%) and 10.10% (2.36%-66.00%), respectively. The median per-capita hospitalisation expense in the eastern, central and western regions were $9374.45 ($2056.13-$18,371.46), $4751.5 ($2951.95-$8768.93) and $3251.25 ($891.64-$13,986.38), respectively. The median average expense per hospitalisation in the eastern and central regions were $6177.15 ($1679.15-$8277.55) and $1285.49 ($1239.93-$2197.36), respectively. The median average length of stay in the eastern, central and western regions were 9.3 days, 15.2 days and 16.1 days, respectively.

CONCLUSIONS

The economic burden of CHD is more severe in mainland China than in developed countries, especially in terms of the direct economic burden. In terms of the types of direct medical expenses, a proportion of medical examination expenses, treatment expenses and drug expenses were lowest in the eastern region, but medical consumables expenses were the highest in this region. This study provides guidance for the formulation of policies to reduce the economic burden of CHD in mainland China.

Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City

Introduction

This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China.

Methods

Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses.

Results

The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001).

Conclusions

The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.

Quantitative cost‑effectiveness index of cancer treatments

In spite of advancements being made in technology and treatment strategies, which have markedly improved the survival rate of patients, the cost of cancer care worldwide has increased over the past decades. The presence of several cost-effectiveness ratios has provided significant indexes to assess the balance between cost and effectiveness. However, the currently available indexes still fail to provide a comprehensive and objective evaluation of cancer treatment. Therefore, the present study developed a novel approach, namely a quantitative cost-effectiveness index of cancer treatment, based on the calculation of the hospitalization expense index and efficacy evaluation index. The present study used the data of 16 patients with childhood acute myeloid leukemia who received the high-dose chemotherapy as an example, and the quantitative cost-effectiveness index was used to evaluate the value of this approach. As the increasing prevalence of cancer and the rising cost of pharmaceuticals have contributed to the expenditure, the development of this index may help to solve the current dilemma of cancer treatment and may prove to be essential for the development of an effective approach which may be accessible to and affordable by common persons; thus would then lead to a higher cure rate.

Change in coronary heart disease hospitalization after chronic disease management: a programme policy in China

This study aims at examining changes in coronary heart disease (CHD) hospitalization associated with a novel county-scale chronic disease management (CDM) programme policy implemented in March 2019 in China during the 13th Five-Year period (2016-2020). The CDM programme was designed to improve the health of populations with chronic diseases by means of an integrated way involving both county-level public hospitals and primary care institutes. Data originated from the medical files of CHD inpatients discharged from a secondary hospital from January 2017 to December 2020. A total of 6111 CHD patient records were collected. Univariate and multivariate regression analyses were performed to assess changes in hospitalization direct medical costs and length of stay of CHD patients. The mean direct medical cost of CHD hospitalization was 8419.73 Yuan, and the mean length of stay was 7.57 days. Results suggested that the implementation of CDM reduced hospitalization direct medical cost and bed days by about 23% (1956.12 Yuan at means) and 11.5% (almost 1 day at means), respectively. In addition, a further decreasing trend in medical costs over time was associated with chronic disease management. It is implied that chronic disease management is an effective way of relieving the medical and financial burden of hospitalization.

A study on the changing trend and influencing factors of hospitalization costs of schizophrenia in economically underdeveloped areas of China

The public health problems caused by schizophrenia are becoming increasingly prominent and can place a huge economic burden on society. This study takes Gansu Province as an example to analyze the level and changing trend of the economic burden of schizophrenia inpatients in economically underdeveloped areas of China. Using a multi-stage stratified cluster sampling method, 39,054 schizophrenics from 197 medical and health institutions in Gansu Province were selected as the research objects, and their medical expenses and related medical records were obtained from the medical information system. The rank sum test and Spearman rank correlation were used for univariate analysis. Quantile regression and random forest were used to analyze the influencing factors. The results show that the average length of stay of schizophrenics in Gansu Province of China was 52.01 days, and the average hospitalization cost was USD1653.96 from 2014 to 2019. During the six years, the average hospitalization costs per time decreased from USD2136.85 to USD1401.33. The average out-of-pocket costs per time decreased from USD1238.78 to USD267.68. And the average daily hospitalization costs increased from USD38.18 to USD41.25. The main factors influencing hospitalization costs are length of stay, proportion of medications, and schizophrenic subtype. The hospitalization costs per time of schizophrenics in Gansu Province have decreased but remain at a high level compared to some other chronic non-communicable diseases. In the future, attention should be paid to improving the efficiency of medical institutions, enhancing community management, and promoting the transformation of the management model of schizophrenia.

The impact of comprehensive public hospital reforms on the direct medical cost of inpatients with coronary heart disease

Objectives

To curb the unreasonable growth of medical expenses and reduce the burden of medical treatment, Beijing launched two rounds of comprehensive reform of public hospitals. In the two reforms, the addition of drugs and consumables was canceled successively. This study compared the changes in the direct medical cost of inpatients with coronary heart disease (CHD) in the three stages of two comprehensive public hospital reforms in Beijing and provides data support for health reform policies.

Setting

CHD diagnosis and treatment data were extracted from the Hospital Information System (HIS) of 33 public hospitals. The total amount and composition of the direct medical expenses of CHD inpatients in the three stages were calculated. Interrupted time series analysis was used to study the instantaneous changes and trend changes in the three stages.

Participants

The data were obtained from the HIS system of 33 public hospitals above the second level in Beijing. A total of 66,647 medical and diagnosis records and 24,371,139 charge detail records were included.

Results

After the two reforms, the total cost for CHD inpatients with most clinical classifications and treatment methods decreased. The proportion of drug and consumable costs decreased significantly, whereas the proportion of medical consultation service costs increased. Drug-treated patients were mainly affected by the instantaneous reforms, percutaneous coronary intervention-treated patients were simultaneously affected by instantaneous and trending effects, and coronary artery bypass graft-treated patients were mainly affected by the reform trend.

Conclusion

The overall change in the direct medical cost of CHD inpatients was consistent with the goal of the comprehensive medical reform of public hospitals in Beijing, which is "total control and structural adjustment."

Hospitalization Expenses and Influencing Factors for Inpatients with Ischemic Heart Disease in Iran: A Retrospective Study

Background: Ischemic heart disease (IHD) is the leading cause of death and disability worldwide and in Iran, which imposes a heavy financial burden both on patient’s family and society. Objectives: This study aimed to analyze the direct medical costs of inpatients with IHD and its influencing factors in Iran in 2020. Methods: The sample of this cross-sectional study included 41,357 patients with IHD selected from the hospital information system (HIS) of the Iran Health Insurance Organization from August 23, 2019, to June 20, 2020. The study used the claims data of these patients, which included their demographics, length of stay (LOS), intensive care unit (ICU) admission, hospital accreditation grade, hospital ownership type, and patient discharge status. The multiple linear regression model was employed to evaluate the relationship between hospitalization costs and the associated factors. All statistical tests were conducted at the significance level of P < 0.05 using the R 3.6.3 software. Results: The mean age of patients was 63.95 ± 12.63 years old, and most of them were male (54.4%). The mean hospitalization cost per patient and per day was 586.42 ± 472.51 USD and 103.64 ± 100.29 USD, respectively. Moreover, the mean LOS was 4.92 days. Drugs and consumable medical supplies, as well as nursing and hoteling services, had the highest shares of hospitalization costs (29.54% and 29.4%, respectively). The hospitalization costs of patients with IHD were higher among men (β = 1.24), age 61 - 70 years (β = 1.38), LOS ≥ 5 (β = 2.92), ICU admission (β = 1.62), Iranian health fund (β = 1.21), and private hospitals (β = 1.91). Top-grade and first-grade hospitals had higher costs compared to grade 2 (β = 0.67), grade 3 (β = 0.35), and grade 4 (β = 0.72) hospitals. Deceased patients had also higher costs than patients with complete recovery (β = 0.63), relative recovery (β = 0.59), follow-up (β = 0.51), transfer to other medical centers (β = 0.44), and discharge against medical advice (DAMA) (β = 0.62). Conclusions: According to the results, shortening the LOS and controlling the high costs of drugs and consumable medical supplies are among the main strategies to reduce high hospitalization costs.

Cost analysis of treating cardiovascular diseases in a super-specialty hospital

Cardiovascular care is expensive; hence, economic evaluation is required to estimate resources being consumed and to ensure their optimal utilization. There is dearth of data regarding cost analysis of treating various diseases including cardiac diseases from developing countries. The study aimed to analyze resource consumption in treating cardio-vascular disease patients in a super-specialty hospital. An observational and descriptive study was carried out from April 2017 to June 2018 in the Department of Cardiology, Cardio-Thoracic (CT) Centre of All India Institute of Medical Sciences, New Delhi, India. As per World Health Organization, common cardiovascular diseases i.e. Coronary Artery Disease (CAD), Rheumatic Heart Disease (RHD), Cardiomyopathy, Congenital heart diseases, Cardiac Arrhythmias etc. were considered for cost analysis. Medical records of 100 admitted patients (Ward & Cardiac Care Unit) of cardiovascular diseases were studied till discharge and number of patient records for a particular CVD was identified using prevalence-based ratio of admitted CVD patient data. Traditional Costing and Time Driven Activity Based Costing (TDABC) methods were used for cost computation. Per bed per day cost incurred by the hospital for admitted patients in Cardiac Care Unit, adult and pediatric cardiology ward was calculated to be Indian Rupee (INR) 28,144 (US$ 434), INR 22,210 (US$ 342) and INR 18,774 (US$ 289), respectively. Inpatient cost constituted almost 70% of the total cost and equipment cost accounted for more than 50% of the inpatient cost followed by human resource cost (28%). Per patient cost of treating any CVD was computed to be INR 2,47,822 (US $ 3842). Cost of treating Rheumatic Heart Disease was the highest among all CVDs followed by Cardiomyopathy and other CVDs. Cost of treating cardiovascular diseases in India is less than what has been reported in developed countries. Findings of this study would aid policy makers considering recent radical changes and massive policy reforms ushered in by the Government of India in healthcare delivery.

The Risk Factors for Chinese Medical Economic Burden of Aging: A Cross-Sectional Study Based on Guangdong Province

Background

The proportion of aging in China is increasing, which needs more healthcare recourses. To analyze the risk factors of the direct medical economic burden of aging in China and provide the strategies to control the cost of treatment, the information was collected based on Guangdong Province's regular health expenditure accounting data collection plan.

Methods

The multiple linear regression models were used to explore the risk factors of inpatient expenses of the elderly in Guangdong province.

Results

The results revealed that hospital day, age, male patients, and patients who suffer from malignant tumors are key factors to increase the direct medical economic burden of aging. Moreover, the medical insurance for urban employees can reduce the medical economic burden, comparing with the medical insurance for urban residents.

Conclusions

The basic medical insurance system and the serious illness insurance system should be improved. While striving to speed up the development of regional economy, the government should pay attention to the construction of basic medical institutions in economically backward areas, increase the allocation of health human resources, and facilitate the masses to seek medical treatment nearby.

Hospitalization Costs and Length of Stay in Chinese Naval Hospitals Between 2008 and 2016 Based on Influencing Factors: A Longitudinal Comparison

INTRODUCTION

A retrospective review conducted in three hospitals of Guangdong and Hainan, China. To analyze the variation tendency of mean hospitalization costs and length of stay (LOS) in naval hospitals over nine years, paying special attention to the factors affecting hospitalization costs and LOS to provide a reference base for health resource allocation in naval hospitals.

MATERIALS AND METHODS

A total of 21,375 cases of military patients who were hospitalized and treated in three naval hospitals between January 2008 to December 2016 were extracted from the military health system. There were 16,278 complete and effective cases during those nine years. The situation, trends, and factors influencing hospitalization costs and LOS were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and multiple linear regressions.

RESULTS

The following factors showed statistically significant differences in hospitalization costs: special care, primary care, year, military rank, critical illness, allergies, and condition (p < 0.0001); and number of hospitalizations, gender, and age (p < 0.01). The following factors showed statistically significant differences in hospital LOS: year, number of hospitalizations, outcomes, military rank, special care, severity of illness, and condition (p < 0.0001); allergy (p < 0.01); and service and gender (p < 0.05). LOS between 2008-2016 showed a decreasing tendency, while hospitalization costs showed an increasing trend. There were 6 factors that affected Abstract (or Structured Summary) both the cost of hospitalization and LOS: special care, year, military rank, condition, allergy, and gender.

CONCLUSIONS

The results suggest that improving efficiency of military hospital require strengthening hierarchical referrals and controlling hospital LOS. Shortening LOS, optimizing clinical pathways, and reasonably controlling the costs associated with medicines and surgery can help reduce hospitalization costs for military patients. Controlling the growth of hospitalization costs can help avoid the physical and psychological burden of medical over-treatment on patients and may also optimize the allocation of military health resources.

How to control the economic burden of treating cardio-cerebrovascular diseases in China? Assessment based on System of Health Accounts 2011

Background

In the past two decades, chronic non-communicable diseases have become the leading disease burden, and cardio-cerebrovascular diseases (CCVD) are the main causes of death in chronic diseases. It has become the focus of global public health attention, in this study, System of Health Accounts 2011 (SHA 2011) is used to calculate health expenditure, discuss its economic burden, and put forward countermeasures.

Methods

Data were collected by multi-stage stratified random sampling and the medical expenses of patients with CCVD were calculated based on SHA 2011, from the dimensions of the financing plan, institutional flow, and service function. Correlation and regression analysis were conducted by controlling factors influencing hospitalization expenses. All analysis were conducted by software SPSS.

Results

The current health expenditure (CHE) of CCVD in Dalian was 3.986 billion Yuan, accounting for 12.88% of the CHE (30.947 billion Yuan). The current curative expenditure (CCE) of CCVD was 2.947 billion Yuan. 40.39% of CCVD financing came from social medical insurance, and the proportion of family health financing was higher (39.06%). The expenditures were consumed by general hospitals and elderly patients.

Conclusions

The expenditure burden of CCVD in Dalian was massive, and wasted the health resource severely. It is necessary for the government to adjust the financing structure, reallocate the expenses of CCVD, and make institutional flow and functional distribution more reasonable.

Evaluating the cost-effectiveness of catheter ablation of atrial fibrillation

Background

The pursuit of a clearer understanding of the pathogenesis of atrial fibrillation (AFib) and the development of new technology has resulted in a surge of interest in the surgical ablation for AFib. Here, we report our 8-year experience in the surgical treatment and management of AFib alongside, evaluating the cost-effectiveness in southern Mainland China over a 1-year follow-up.

Methods

Data of 3,068 patients from March 2011 through June 2019 was retrospectively extracted from The Provincial National Cardiac Database of Xiangya Second Hospital. The activities considered (and costs calculated) were outpatient consultations, hospital admissions, and drug treatment. Quality of life (QoL) questionnaires were also carried out to assess whether concomitant AFib correction procedures increase risk in patients, or improve patient's QoL.

Results

A total of 3,068 patients completed the questionnaires at a minimum of one time-point during the follow-up. The total cost was combined to obtain incremental costs per quality-adjusted life-years (QALYs). The total costs of the AFib catheter ablation group were remarkably higher compared to surgery as usual group. The incremental cost-effectiveness ratio was $76,513,227 (¥542,287,667) per QALY, with an acceptability line graph for cost at 43%.

Conclusions

AFib is an extraordinarily costly and worrisome public health problem. Precision medicine is vital as it provides a platform for the clinical translation of targeted interventions that are designed to help treat and prevent AFib. Thus, to improve the QoL expectancy outcome(s), both therapeutic and surgical interventions should be aimed at addressing the underlying heart disease rather than restoring sinus rhythm.

Comparative analysis of cost-effectiveness between isosorbide-5-mononitrate and isosorbide: a retrospective real-world evaluation

Aim: The cost-effectiveness of isosorbide-5-mononitrate (5-ISMN) and isosorbide dinitrate (ISDN) in real-world use in patients with coronary heart disease (CHD; either angina pectoris or myocardial infarction) was retrospectively compared. Method: In this retrospective real-world evaluation, patients with established CHD satisfying the following criteria were selected from information system of two tertiary hospitals in China: with pharmacy claiming for at least one injection of 5-ISMN or ISDN between July 2008 and May 2017; and, CHD patients. By using propensity score matching (PSM), we compared clinical aspects of efficacy, safety, length of hospital stay and cost during hospitalization between 5-ISMN and ISDN group. All data were processed by R statistical package v.2.13.1 (R Foundation for Statistical Computing, Vienna, Austria). Result: Of 5609 patients selected, 4047 received 5-ISMN and 1562 received ISDN. After PSM, we acquired 1555 pairs based on balancing of age, sex, insurance and comorbidities on admission. The frequency (4.2 ± 6.6-times vs 6.5 ± 9.5-times; p < 0.05) and total dosage (47.5 ± 153.4 vs 136.4 ± 261.0 mg; p < 0.05) of sublingual nitroglycerin use decreased and hypotension incidence lowered (8.0 vs 13.0%; p < 0.05) in 5-ISMN group compared with ISDN group. Hospital stay (16.0 ± 11.3 days vs 17.7 ± 13.2; p < 0.05) and hospitalization expenditure ([the ratio of cost in the study to the average hospitalization cost in the city] [odds ratio: 2.5 vs 2.6; p < 0.05]) were reduced in 5-ISMN group as with that of ISDN group. Moreover, the main component of hospitalization cost was medical consumables and medications in both the groups. Conclusion: In the present retrospective real-world evaluation, by using PSM analysis, we found that newer injection agent of 5-ISMN was associated with fewer use of sublingual nitroglycerin, less hypotension incidence, shorter length of hospital stay and less hospitalization expenditure related to its comparator ISDN in patients with established CHD. Further evaluation and clinical experience are need in different circumference for the usage of ISDN.

Socioeconomic differences in health-care use and outcomes for stroke and ischaemic heart disease in China during 2009-16: a prospective cohort study of 0·5 million adults

BACKGROUND

China initiated major health-care reforms in 2009 aiming to provide universal health care for all by 2020. However, little is known about trends in health-care use and health outcomes across different socioeconomic groups in the past decade.

METHODS

We used data from the China Kadoorie Biobank (CKB), a nationwide prospective cohort study of adults aged 30-79 years in 2004-08, in ten regions (five urban, five rural) in China. Individuals who were alive in 2009 were included in the present study. Data for all admissions were obtained by linkage to electronic hospital records from the health insurance system, and to region-specific disease and death registers. Generalised linear models were used to estimate trends in annual hospital admission rates, 28-day case fatality rates, and mean length of stay for stroke, ischaemic heart disease, and any cause in all relevant individuals.

FINDINGS

512 715 participants were recruited to the CKB between June 25, 2004, and July 15, 2008, 505 995 of whom were still alive on Jan 1, 2009, and contributed to the present study. Among them, we recorded 794 824 hospital admissions (74 313 for stroke, 69 446 for ischaemic heart disease) between 2009 and 2016. After adjustment for demographic, socioeconomic, lifestyle, and morbidity factors, hospitalisation rates increased annually by 3·6% for stroke, 5·4% for ischaemic heart disease, and 4·2% for any cause, between 2009 and 2016. Higher socioeconomic groups had higher hospitalisation rates, but the annual proportional increases were higher in those with lower education or income levels, those enrolled in the urban or rural resident health insurance scheme, and for those in rural areas. Lower socioeconomic groups had higher case fatality rates for stroke and ischaemic heart disease, but greater reductions in case fatality rates than higher socioeconomic groups. By contrast, mean length of stay decreased by around 2% annually for stroke, ischaemic heart disease, and any cause, but decreased to a greater extent in higher than lower socioeconomic groups for stroke and ischaemic heart disease.

INTERPRETATION

Between 2009 and 2016, lower socioeconomic groups in China had greater increases in hospital admission rates and greater reductions in case fatality rates for stroke and ischaemic heart disease. Additional strategies are needed to further reduce socioeconomic differences in health-care use and disease outcomes.

FUNDING

Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and Chinese National Natural Science Foundation.

Factors Associated With Hospitalization Costs of Coronary Heart Disease in Township Hospitals in Rural China

In large proportions of rural areas in many developing countries, health care delivery system is less developed and is less likely to be equipped to conduct sophisticated treatment for coronary heart disease (CHD) patients locally. This study aims at describing the status quo of and exploring factors associated with hospitalization costs of CHD in township hospitals where only drug therapy was available for CHD conditions. We collected data of inpatients with CHD from discharge records from 10 township hospitals in rural Liaoning from December 2013 to December 2014. We used multilevel linear regression to analyze the factors associated with CHD hospitalization costs. A total of 4635 inpatients were included in the analysis. We found that the average hospitalization costs were 6249.97 RMB (US$1012.47) with the average of 8.89 days of hospitalization in township hospitals in Liaoning. Age, gender, length of stay, the number of times of admissions, by which route was hospitalized, and type of CHD were all the factors significantly associated with hospitalization costs of CHD in township hospitals. The factors associated with hospitalization costs of CHD in township hospitals in rural China showed some different features from the existing studies. When the government designs the related policy, the policy makers need to consider the specific feature of hospitalization costs of CHD in township hospitals in rural areas.