Dawei Zhu - China Center for Health Development Studies, Peking University, Beijing, China
Shi Xuefeng - School of Management, Beijing University of Chinese Medicine, Beijing, China
Stephen Nicholas - School of Economics and School of Management, Tianjin Normal University, Tianjin, China
Siyuan Chen - School of Public Health, Peking University, Beijing, China
Ruoxi Ding - Institute of Population Research, Peking University, Beijing, China
Lieyu Huang - School of Management, Beijing University of Chinese Medicine, Beijing, China
Yong Ma - China Health Insurance Research Association, Beijing, China
Ping He - China Center for Health Development Studies, Peking University, Beijing, China

BackgroundUnderstanding the treatment costs of stroke can guide health policies and interventions. However, few studies have analyzed the treatment costs of stroke in China. The aim of this study is to assess stroke-related medical service utilization, direct costs of stroke and associated stroke predictors, and, second, to understand the structure of medical resource use. MethodsThis study used a ۵% random sample of claim data from China’s Urban Basic Medical Insurance between January ۲۰۱۳ to December ۲۰۱۶. The sampling design assigned a sample weight to each beneficiary. Weighted descriptive analyses, Poisson regression and generalized linear model were used to analyze the medical service utilization, costs and their associations with patient characteristics. ResultsIn urban China, the annual prevalence of stroke was ۷۳۰.۴۳ (۹۵% CI = ۷۳۰.۱۰-۷۳۰.۷۶) cases per ۱۰۰ ۰۰۰ people, and nearly ۲% of total health expenditures of urban residents was spent on stroke-related medical costs. Weighted average annual total medical cost of stroke was RMB۱۰ ۶۳۷ [۹۵% CI = ۱۰ ۴۳۵-۱۰ ۸۴۰] (US۱۶۸۲, ۹۵% CI = ۱۶۵۰-۱۷۱۴), with annual out-of-pocket (OOP) cost of RMB۳۰۹۳ [۹۵% CI = ۳۰۲۶-۳۱۶۱] (US۴۸۹, ۹۵% CI = ۴۷۸-۵۰۰). The average yearly number of stroke-related outpatient visit was ۱.۶۷ [SD = ۳.۳۹] and inpatient admission was ۰.۷۹ [SD = ۰.۸۳], with an average cost of RMB۴۴۰ [SD = ۷۳۹] (US۷۰, SD = ۱۱۷) for outpatients and RMB۱۲ ۷۰۲ [SD = ۲۱ ۴۲۴] (US۲۰۰۸, SD = ۳۳۸۷) for inpatients. Inpatient costs accounted for ۹۴% (RMB۱۰ ۰۳۴ or US ۱۵۸۶) of medical costs, and tertiary hospitals were the main provider of stroke care. Stroke-related medical care utilization and direct costs were associated with gender, age, pathological stroke types and insurance status. Medication costs contributed to ۵۰.۶% (RMB۵۳۸۲ or US ۸۵۱) of the average stroke-related medical costs. ConclusionChina’s health system bares a large economic burden from stroke. Specific policies are needed to strengthen the capacity of secondary hospitals, alter the structure of medical resource allocation, and target specific sections of the stroke population.

Stroke, Medical Service Utilization, Direct Medical Cost, Urban China, Cost of Illness, Treatment Cost