Heeley Emma, Anderson Craig S, Huang Yining, Jan Stephen, Li Yan, Liu Ming, Sun Jian, Xu En, Wu Yangfeng, Yang Qidong, Zhang Jingfen, Zhang Shihong, Wang Jiguang
The George Institute for International Health, Royal Prince Alfred Hospital and the University of Sydney, Sydney, Australia.
Stroke. 2009 Jun;40(6):2149-56. doi: 10.1161/STROKEAHA.108.540054. Epub 2009 Apr 9.
Stroke is a major health burden in China, but there are limited data on its economic effects on households. We aimed to examine the economic impact of stroke and to assess the influence of health insurance.
In a nationwide, prospective, 62-hospital registry study of acute stroke in China, we recorded information on patient demographics, clinical features, socioeconomic factors, management, and costs of medical care. Information on out-of-pocket health expenses was obtained in surviving patients at 3- and 12-month follow-up. Catastrophic healthcare payments, defined as >or=30% of total household annual income, were estimated from reported household annual income.
Among 4739 3-month survivors of stroke with outcome data, average hospital and medication costs were 16,525 Chinese Yuan Renminbi (US $2361) and out-of-pocket costs were 14,478 Chinese Yuan Renminbi (US $2068). Overall, 3384 (71%) patients had experienced catastrophic out-of-pocket expenditure. Workers without health insurance were 7 times (OR, 6.9; 95% CI, 4.6 to 10.3) more likely to experience catastrophic payments than workers with insurance. Health insurance also protected against catastrophic payments in patients who were either retired or not working (no insurance: OR, 4.7; 95% CI, 3.1 to 7.2; OR, 1.82; 95% CI, 1.3 to 2.6, respectively).
Because healthcare costs are high relative to income in China, families face considerable economic hardship after stroke. Health insurance protects families against catastrophic healthcare payments, thus highlighting the need to accelerate the ongoing process of building a comprehensive healthcare system in both urban and rural settings in China.
中风是中国一项重大的健康负担，但关于其对家庭经济影响的数据有限。我们旨在研究中风的经济影响，并评估医疗保险的作用。
在中国一项全国性、前瞻性、62家医院参与的急性中风登记研究中，我们记录了患者的人口统计学信息、临床特征、社会经济因素、治疗情况及医疗费用。在存活患者3个月和12个月随访时获取自付医疗费用信息。根据报告的家庭年收入估算灾难性医疗支出，定义为家庭年收入的≥30%。
在4739例有结局数据的中风3个月幸存者中，平均住院和药物费用为16525元人民币（2361美元），自付费用为14478元人民币（2068美元）。总体而言，3384例（71%）患者经历了灾难性自付支出。没有医疗保险的在职人员发生灾难性支出的可能性是有保险在职人员的7倍（比值比，6.9；95%置信区间，4.6至10.3）。医疗保险也能防止退休或无业患者发生灾难性支出（无保险：比值比分别为4.7；95%置信区间，3.1至7.2；1.82；95%置信区间，1.3至2.6）。
由于在中国医疗费用相对于收入较高，中风后家庭面临相当大的经济困难。医疗保险可保护家庭避免灾难性医疗支出，因此凸显了加快在中国城乡建立全面医疗体系进程的必要性。
