School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Division of Comprehensive, China Science and Technology Exchange Center, Beijing, China.
Front Public Health. 2022 Oct 28;10:994529. doi: 10.3389/fpubh.2022.994529. eCollection 2022.
Malaria burden is still worrisome, while empirical evidence from malaria-eliminated countries including China may provide inspiration for the world.
This study aimed to investigate China's malaria hospitalization costs and explore its determinants.
Stratified multistage sampling across provincial, municipal, and county hospitals was conducted in 2017. All the malaria medical records were retrieved from 2014 to 2016 in 70 hospitals. Parametric and non-parametric methods were employed to estimate hospitalization costs, and the non-parametric bootstrap was used to compare hospitalization costs among sample areas and assessed the uncertainty of its differences. Quantile regressions were conducted to identify the determinants of hospitalization costs.
The median hospitalization costs of 1633 malaria inpatients were 628 USD. Medication and laboratory tests accounted for over 70% of total expenditure. The median reimbursement rate was 41.87%, and this number was even lower in higher-level hospitals (<35%) and among the New Rural Cooperative Medical Scheme (<40%). Finally, health insurance type, hospital tier, clinical units, unknown fever, and comorbidity were the main determinants of hospitalization costs.
The disparity of health protection for malaria hospitalization between rural and urban areas was noteworthy. Equivocal diagnosis and comorbidity are contributors of high cost as well. A reasonable payment system and enhanced capacities to treat malaria in a cost-effective way are suggested to reassure malaria economic burden.
疟疾负担仍然令人担忧，而包括中国在内的已消除疟疾国家的经验证据可能为世界提供启示。
本研究旨在调查中国疟疾住院费用及其决定因素。
2017 年采用分层多阶段抽样方法对省级、市级和县级医院进行抽样。从 70 家医院中检索了 2014 年至 2016 年所有疟疾病历。采用参数和非参数方法估计住院费用，并采用非参数自举法比较样本地区的住院费用，并评估其差异的不确定性。进行分位数回归以确定住院费用的决定因素。
1633 名疟疾住院患者的中位数住院费用为 628 美元。药物和实验室检查占总支出的 70%以上。中位数报销率为 41.87%，在较高级别医院（<35%）和新型农村合作医疗制度（<40%）中，这一数字甚至更低。最后，医疗保险类型、医院级别、临床科室、不明原因发热和合并症是住院费用的主要决定因素。
农村和城市地区疟疾住院费用的健康保障差异值得关注。诊断不明确和合并症也是费用高的原因。建议建立合理的支付制度，提高疟疾的成本效益治疗能力，以减轻疟疾的经济负担。
