Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Design
2.3. Cost Estimation
2.4. Measures and Variables
2.5. Statistical Analysis
2.6. Ethical Considerations
3. Results
3.1. Patient Characteristics
3.2. Hospitalization Costs of Dementia and Cost Composition by Types of Insurance
3.3. Patient Characteristics Associated with Inpatient Costs by Types of Insurance
3.4. Influential Factors of Total Inpatient Costs
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Inception Year | UEBMI | URBMI | ||||
---|---|---|---|---|---|---|
2002 | 2008 | |||||
Eligible population | Urban employed (Employees; Retirees) | Urban non-employed (Children & full-time Students; Unemployed adults; Elderly residents not covered by the UEBMI scheme) | ||||
Sources of funding | The employers contribute 6% of the employee’s salary whilst the employees contribute 2%; Retirees are exempted from premium contribution | Government subsidy (70%) and individual premium (30%) CNY440 to CNY1800 per person per year for residents (including government subsidy) | ||||
Accounts | Medical Savings Account (including employee contributions and 30% of employer contributions) for outpatient care; Social Risk-pooling Account (70% of employer contributions) for inpatient care and critical (i.e., chronic or fatal diseases) outpatient care | Social Risk-pooling Account (all funds) for inpatient care and critical (i.e., chronic or fatal diseases) outpatient care | ||||
Inpatient | Inpatient | |||||
Deductible: (Inpatient care) | Employees | Primary hospitals | CNY 400 | Children & students | Primary hospitals | CNY 120 |
Secondary hospitals | CNY 800 | Secondary hospitals | CNY 240 | |||
Tertiary hospitals | CNY 1600 | Tertiary hospitals | CNY 480 | |||
Retirees | Primary hospitals | CNY 280 | Unemployed adults and Elderly residents | Primary hospitals | CNY 280 | |
Secondary hospitals | CNY 560 | Secondary hospitals | CNY 560 | |||
Tertiary hospitals | CNY 1120 | Tertiary hospitals | CNY 1120 | |||
Reimbursement rate * (Inpatient care) | Employees | Primary hospitals | 90% | Children & students | Primary hospitals | 85% |
Secondary hospitals | 85% | Secondary hospitals | 75% | |||
Tertiary hospitals | 80% | Tertiary hospitals | 65% | |||
Retirees | Primary hospitals | 93% | Unemployed adults and Elderly residents | Primary hospitals | 75% | |
Secondary hospitals | 89.5% | Secondary hospitals | 65% | |||
Tertiary hospitals | 86% | Tertiary hospitals | 55% | |||
Reimbursed ceiling | Six times of local employees’ annual average wage | Six times of local household disposable income | ||||
(Inpatient care) | CNY 382,512 | CNY 228,324 |
Patient Characteristics | Overall | UEBMI | URBMI |
---|---|---|---|
No. Patients | 5747 | 5013 | 734 |
Gender | |||
Female | 3288.0 (57.2) | 2893.0 (57.7) | 395.0 (53.8) |
Male | 2459.0 (42.8) | 2120.0 (42.3) | 339.0 (46.2) |
Age (years) | |||
Mean ± SD | 77.4 ± 10.0 | 77.6 ± 9.7 | 76.1 ± 12.0 |
Median (25th–75th) | 79.0 (72.0–84.0) | 79.0 (73.0–84.0) | 76.0 (70.0–85.0) |
Age group | |||
18 ≤ age < 50 | 56.0 (1.0) | 30.0 (0.6) | 26.0 (3.5) |
50 ≤ age < 60 | 332.0 (5.8) | 280.0 (5.6) | 52.0 (7.1) |
60 ≤ age < 70 | 670.0 (11.7) | 582.0 (11.6) | 88.0 (12.0) |
70 ≤ age < 80 | 1967.0 (34.2) | 1711.0 (34.1) | 256.0 (34.9) |
80 ≤ age < 85 | 1391.0 (24.2) | 1267.0 (25.3) | 124.0 (16.9) |
≥85 | 1331.0 (23.2) | 1143.0 (22.8) | 188.0 (25.6) |
Insurance type | |||
UEBMI | 5013.0 (87.2) | 5013.0 (100.0) | 0.0 (0.0) |
URBMI | 734.0 (12.8) | 0.0 (0.0) | 734.0 (100.0) |
Disease type | |||
AD | 3448.0 (60.0) | 2911.0 (58.1) | 537.0 (73.2) |
VaD | 1338.0 (23.3) | 1214.0 (24.2) | 124.0 (16.9) |
Others | 961.0 (16.7) | 888.0 (17.7) | 73.0 (9.9) |
Comorbidities | |||
None | 3258.0 (56.7) | 2698.0 (53.8) | 560.0 (76.3) |
Hypertension | 2238.0 (38.9) | 2067.0 (41.2) | 171.0 (23.3) |
Diabetes | 413.0 (7.2) | 407.0 (8.1) | 6.0 (0.8) |
Coronary | 779.0 (13.6) | 742.0 (14.8) | 37.0 (5.0) |
Hospital level | |||
Primary | 358.0 (6.2) | 330.0 (6.6) | 28.0 (3.8) |
Secondary | 2026.0 (35.3) | 1803.0 (36.0) | 223.0 (30.4) |
Tertiary | 3363.0 (58.5) | 2880.0 (57.5) | 483.0 (65.8) |
Length of stay (days) | |||
Mean ± SD | 24.2 ± 21.6 | 22.8 ± 19.9 | 33.7 ± 29.0 |
Median (25th–75th) | 17.0 (12.0–30.0) | 17.0 (12.0–29.0) | 29.0 (11.0–34.0) |
Days ≤ 10 | 1137.0 (19.8) | 972.0 (19.4) | 165.0 (22.5) |
10 < Days ≤ 15 | 1314.0 (22.9) | 1209.0 (24.1) | 105.0 (14.3) |
15 < Days ≤ 30 | 1990.0 (34.6) | 1823.0 (36.4) | 167.0 (22.8) |
30 < Days ≤ 60 | 830.0 (14.4) | 685.0 (13.7) | 145.0 (19.8) |
>60 Days | 476.0 (8.3) | 324.0 (6.5) | 152.0 (20.7) |
Direct Inpatient Costs | Overall | UEBMI | URBMI | p-Value |
---|---|---|---|---|
No. Patients | 5747 | 5013 | 734 | |
Total inpatient costs | 0.000 | |||
Mean (CNY) | 9169.0 | 9425.0 | 7420.5 | |
SD | 7899.1 | 8239.6 | 4625.2 | |
Laboratory and diagnostic costs | 0.000 | |||
Percentage of total inpatient cost (%) | 9.7 | 10.1 | 6.1 | |
Mean (CNY) | 887.7 | 951.0 | 455.3 | |
SD | 1599.2 | 1662.3 | 969.8 | |
Non-medication treatment costs | 0.000 | |||
Percentage of total inpatient cost (%) | 38.5 | 38.7 | 36.4 | |
Mean (CNY) | 3526.6 | 3647.5 | 2700.8 | |
SD | 3603.9 | 3727.6 | 2454.2 | |
Medication costs | 0.000 | |||
Percentage of total inpatient cost (%) | 38.4 | 38.5 | 37.9 | |
Mean (CNY) | 3524.3 | 3628.2 | 2814.4 | |
SD | 3946.1 | 4116.6 | 2370.0 | |
Bed fees | 0.000 | |||
Percentage of total inpatient cost (%) | 9.2 | 8.7 | 13.9 | |
Mean (CNY) | 847.2 | 820.5 | 1029.0 | |
SD | 779.2 | 752.7 | 920.5 | |
Other fees | 0.000 | |||
Percentage of total inpatient cost (%) | 4.2 | 4.0 | 5.7 | |
Mean (CNY) | 383.3 | 377.8 | 421.0 | |
SD | 414.9 | 425.2 | 334.6 | |
Out-of-pocket spending | 0.539 | |||
Percentage of total inpatient cost (%) | 19.3 | 18.1 | 30.0 | |
Mean (CNY) | 1771.9 | 1705.9 | 2222.3 | |
SD | 1841.8 | 1683.0 | 2643.9 |
Patient Characteristics | Overall | UEBMI | URBMI | p-Value | |||
---|---|---|---|---|---|---|---|
No. Patients | n = 5747 | n = 5013 | n = 734 | ||||
Mean | SD | Mean | SD | Mean | SD | ||
Gender | 0.077 | ||||||
Female | 8880.5 | 7905.2 | 9143.9 | 8239.4 | 6951.2 | 4336.8 | |
Male | 9554.8 | 7875.9 | 9808.6 | 8226.3 | 7967.3 | 4889.8 | |
Age group | 0.000 | ||||||
18 ≤ age < 50 | 9310.4 | 3822.0 | 10,122.4 | 4244.6 | 8373.4 | 3087.5 | |
50 ≤ age < 60 | 10,278.0 | 8611.8 | 10,523.7 | 9190.0 | 8954.9 | 4146.0 | |
60 ≤ age < 70 | 9721.0 | 7869.2 | 10,024.8 | 8119.6 | 7712.1 | 5586.3 | |
70 ≤ age < 80 | 9936.5 | 8828.9 | 10,351.7 | 9282.8 | 7161.5 | 3772.2 | |
80 ≤ age < 85 | 8585.7 | 7212.7 | 8709.8 | 7438.3 | 7317.4 | 4081.1 | |
≥85 | 8083.9 | 6848.0 | 8237.7 | 7014.6 | 7148.5 | 5658.5 | |
Insurance type | \ | ||||||
UEBMI | 9425.0 | 8239.6 | 9425.0 | 8239.6 | \ | \ | |
URBMI | 7420.5 | 4625.1 | \ | \ | 7420.5 | 4625.1 | |
Disease type | 0.000 | ||||||
AD | 8251.9 | 7394.7 | 8477.4 | 7820.9 | 7029.8 | 4219.8 | |
VaD | 9934.0 | 7451.2 | 10,188.6 | 7670.2 | 7442.2 | 4052.7 | |
Others | 11,394.2 | 9539.4 | 11,487.7 | 9720.5 | 10,257.8 | 6918.4 | |
Comorbidities | 0.000 | ||||||
None | 8808.6 | 7965.6 | 9065.8 | 8452.3 | 7569.3 | 4811.2 | |
Hypertension | 9730.3 | 8058.1 | 9971.0 | 8266.4 | 6821.4 | 3842.4 | |
Diabetes | 10,118.2 | 7378.7 | 10,077.9 | 7407.1 | 12,847.0 | 4703.9 | |
Coronary | 10,019.0 | 7497.4 | 10,116.1 | 7619.1 | 8071.7 | 3979.4 | |
Hospital level | 0.000 | ||||||
Primary | 5538.6 | 3256.6 | 5615.4 | 3264.1 | 4633.1 | 3079.7 | |
Secondary | 6733.0 | 5427.8 | 6879.0 | 5642.8 | 5552.9 | 2950.5 | |
Tertiary | 11,023.0 | 8907.9 | 11,455.4 | 9337.9 | 8444.4 | 4987.5 | |
Length of stay (days) | 0.000 | ||||||
Days ≤ 10 | 6873.5 | 3583.1 | 7044.4 | 3566.8 | 5866.5 | 3523.0 | |
10 < Days ≤ 15 | 8996.5 | 4543.6 | 9132.3 | 4575.5 | 7432.1 | 3844.0 | |
15 < Days ≤ 30 | 9056.7 | 6012.4 | 9173.4 | 5878.5 | 7783.5 | 7215.9 | |
30 < Days ≤ 60 | 8504.1 | 8758.4 | 8933.3 | 9496.0 | 6476.4 | 2876.2 | |
>60 Days | 16,757.1 | 17,622.2 | 20,114.1 | 20,449.4 | 9601.3 | 2574.5 |
Influential Factors | Overall | UEBMI | URBMI | ||||||
---|---|---|---|---|---|---|---|---|---|
n = 5747 | n = 5013 | n = 734 | |||||||
Coef. | Adjusted Std. err. | Marginal Effect | Coef. | Adjusted Std. err. | Marginal Effect | Coef. | Adjusted Std. err. | Marginal Effect | |
Gender | |||||||||
Female (Reference) | |||||||||
Male | 0.043 | 0.028 | 409.2 | 0.063 ** | 0.024 | 594.1 | 0.033 | 0.089 | 262.3 |
Age group | |||||||||
18 ≤ age < 50 (Reference) | |||||||||
50 ≤ age < 60 | 0.055 | 0.116 | 540.0 | −0.053 | 0.108 | −494.9 | 0.240 | 0.168 | 2342.6 |
60 ≤ age < 70 | 0.073 | 0.097 | 720.2 | −0.020 | 0.083 | −186.9 | 0.233 | 0.217 | 2184.3 |
70 ≤ age < 80 | 0.092 | 0.093 | 886.8 | −0.016 | 0.077 | −152.5 | 0.160 | 0.188 | 1352.3 |
80 ≤ age < 85 | 0.043 | 0.096 | 415.9 | −0.060 | 0.079 | −562.1 | 0.260 | 0.211 | 2393.7 |
≥85 | 0.074 | 0.095 | 722.7 | −0.057 | 0.078 | −530.1 | 0.352 | 0.208 | 3645.1 |
Insurance type | |||||||||
URBMI (Reference) | |||||||||
UEBMI | 0.200 *** | 0.046 | 1714.2 | \ | \ | \ | \ | \ | \ |
Disease type | |||||||||
AD (Reference) | |||||||||
VaD | 0.136 *** | 0.030 | 1354.4 | 0.135 *** | 0.027 | 1317.3 | 0.069 | 0.089 | 564.4 |
Others | 0.212 *** | 0.033 | 2209.9 | 0.158 *** | 0.03 | 1567.3 | 0.426 *** | 0.12 | 3982.2 |
Comorbidities | |||||||||
None (Reference) | |||||||||
Hypertension | 0.091 *** | 0.028 | 870.3 | 0.067 *** | 0.026 | 642.7 | 0.101 | 0.083 | 793.2 |
Diabetes | 0.049 | 0.037 | 481.2 | 0.040 | 0.036 | 384.7 | 0.370 ** | 0.166 | 3724.5 |
Coronary | 0.049 | 0.033 | 471.9 | 0.046 | 0.03 | 445.7 | 0.082 | 0.103 | 672.1 |
Hospital level | |||||||||
Primary (Reference) | |||||||||
Secondary | 0.252 *** | 0.039 | 2702.0 | 0.215 *** | 0.032 | 2128.5 | 0.213 | 0.197 | 1950.9 |
Tertiary | 0.721 *** | 0.054 | 6129.6 | 0.693 *** | 0.048 | 6153.0 | 0.731 *** | 0.23 | 5097.8 |
Length of stay (days) | |||||||||
Days ≤ 10 (Reference) | |||||||||
10 < Days ≤ 15 | 0.301 *** | 0.024 | 3297.5 | 0.308 *** | 0.023 | 3168.3 | 0.216 *** | 0.077 | 1908.8 |
15 < Days ≤ 30 | 0.355 *** | 0.029 | 3822.4 | 0.372 *** | 0.028 | 3753.4 | 0.218 ** | 0.105 | 1869.4 |
30 < Days ≤ 60 | 0.253 *** | 0.050 | 2778.1 | 0.295 *** | 0.053 | 3073.4 | −0.030 | 0.112 | −228.5 |
>60 Days | 0.934 *** | 0.092 | 16,731.8 | 1.178 *** | 0.141 | 16,933.1 | 0.532 *** | 0.138 | 7500.0 |
Year | |||||||||
year 2008 (Reference) | |||||||||
year 2009 | 0.169 *** | 0.047 | 1746.7 | 0.178 *** | 0.039 | 1782.0 | 0.146 *** | 0.053 | 1280.9 |
year 2010 | 0.181 *** | 0.048 | 1905.5 | 0.149 *** | 0.035 | 1488.9 | 0.134 | 0.120 | 1176.5 |
year 2011 | 0.135 *** | 0.042 | 1357.7 | 0.109 *** | 0.032 | 1063.4 | 0.290 *** | 0.109 | 2813.6 |
year 2012 | 0.174 *** | 0.042 | 1755.7 | 0.124 *** | 0.032 | 1199.2 | 0.328 *** | 0.109 | 3002.9 |
year 2013 | 0.199 *** | 0.040 | 2071.8 | 0.178 *** | 0.032 | 1772.4 | 0.288 | 0.151 | 2795.3 |
λ | −0.321 | 0.197 | 0.136 | 0.122 | −0.614 | 0.463 | |||
θ1 | 0.361 *** | 0.022 | 0.314 *** | 0.013 | 0.276 *** | 0.090 | |||
θ2 | 3.056 *** | 0.141 | 3.218 *** | 0.086 | 2.042 *** | 0.695 |
Influential Factors | Overall | ||
---|---|---|---|
n = 5747 | |||
Coef. | Adjusted Std. err. | Marginal Effect | |
Gender | |||
Female (Reference) | |||
Male | 0.057 ** | 0.026 | 532.7 |
Age group | |||
18 ≤ age < 50 (Reference) | |||
50 ≤ age < 60 | 0.022 | 0.103 | 209.1 |
60 ≤ age < 70 | 0.042 | 0.086 | 392.6 |
70 ≤ age < 80 | 0.055 | 0.081 | 514.6 |
80 ≤ age < 85 | 0.020 | 0.084 | 187.9 |
≥85 | 0.041 | 0.083 | 384.4 |
Insurance type | |||
URBMI (Reference) | |||
UEBMI | −0.013 | 0.051 | −118.9 |
Disease type | |||
AD (Reference) | |||
VaD | 0.133 *** | 0.028 | 1283.8 |
Others | 0.192 *** | 0.031 | 1908.1 |
Comorbidities | |||
None (Reference) | |||
Hypertension | 0.079 *** | 0.026 | 737.1 |
Diabetes | 0.054 | 0.036 | 516.9 |
Coronary | 0.051 | 0.032 | 481.3 |
Hospital level | |||
Primary (Reference) | |||
Secondary | 0.227 *** | 0.034 | 2263.5 |
Tertiary | 0.706 *** | 0.049 | 6026.8 |
Length of stay (days) | |||
Days ≤ 10 (Reference) | |||
10 < Days ≤ 15 | 0.222 *** | 0.059 | 2218.6 |
15 < Days ≤ 30 | 0.224 ** | 0.088 | 2183.4 |
30 < Days ≤ 60 | −0.047 | 0.091 | −428.0 |
>60 Days | 0.313 *** | 0.075 | 3294.8 |
Year | |||
year 2008 (Reference) | |||
year 2009 | 0.160 *** | 0.040 | 1579.9 |
year 2010 | 0.148 *** | 0.040 | 1470.8 |
year 2011 | 0.107 *** | 0.037 | 1027.1 |
year 2012 | 0.137 *** | 0.036 | 1318.0 |
year 2013 | 0.177 *** | 0.036 | 1749.4 |
Insurance type × Length of stay (LOS) | |||
UEBMI × (10 < Days ≤ 15) | 0.093 | 0.060 | 892.3 |
UEBMI × (15 < Days ≤ 30) | 0.151 | 0.091 | 1452.4 |
UEBMI × (30 < Days ≤ 60) | 0.347 *** | 0.105 | 3775.4 |
UEBMI × (>60 Days) | 0.824 *** | 0.155 | 11,517.0 |
λ | −0.321 | 0.197 | |
θ1 | 0.361 *** | 0.022 | |
θ2 | 3.056 *** | 0.141 |
Research | Country/Region | Year of Data | Costs in Article | Adjusted Costs * | Including Medication or Not |
---|---|---|---|---|---|
This Study | Guangzhou China | 2013 | CNY 9169.0 | US$1479.8 | YES |
Hurd, et al. [13] | United States | 2010 | US$8946 | US$9471.3 | YES |
Schwarzkopf, et al. [15] | Germany | 2008 | € 3914 | US$5403.9 | NO |
Kang, et al. [16] | Korea | 2004 | US$4296 | US$5156.2 | YES |
Abdin, et al. [17] | Singapore | 2013 | US$7178 | US$5521.5 | YES |
Gustavsson, et al. [18] | Northern Europe | 2006 | € 651 | US$905.9 | NO |
Gustavsson, et al. [18] | Western Europe | 2006 | € 710 | US$955.9 | NO |
Gustavsson, et al. [18] | Southern Europe | 2006 | € 450 | US$682.3 | NO |
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Share and Cite
Zhang, H.; Zhang, D.; Yin, Y.; Zhang, C.; Huang, Y. Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City. Int. J. Environ. Res. Public Health 2019, 16, 2781. https://doi.org/10.3390/ijerph16152781
Zhang H, Zhang D, Yin Y, Zhang C, Huang Y. Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City. International Journal of Environmental Research and Public Health. 2019; 16(15):2781. https://doi.org/10.3390/ijerph16152781
Chicago/Turabian StyleZhang, Hui, Donglan Zhang, Yujie Yin, Chao Zhang, and Yixiang Huang. 2019. "Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City" International Journal of Environmental Research and Public Health 16, no. 15: 2781. https://doi.org/10.3390/ijerph16152781