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.

No abstract

Background: Cancer poses a severe health hazard and a heavy economic burden to mankind. This study, applying the System of Health Accounts 2011 (SHA 2011), aimed to calculate the economic burden of neoplasm in Gansu of China, and to find out problems in the entire financial flow of neoplasm treatment service delivery (including financing scheme, services provider, disease and patients distribution), and to explore influencing factors of hospitalization expenditure with neoplasms.Methods: Macro data was obtained from official yearbook and sampling data were collected with multistage stratified sampling method. Top-down approach was performed to decompose the Current Curative Expenditure (CCE) of neoplasm and the formula to calculate CCE was introduced step-by-step. Multiple linear regression and random forest regression model were used to analyze influencing factors of hospitalization expenditure with neoplasms.Results: The CCE of neoplasm amounted to 4442.269 million CNY in Gansu 2017, more than half of which were directly burdened by patients and their family, and patients were over-reliant on inpatient service provided by hospitals while the service delivered by primary health care establishment were not fully utilized. The middle-aged adults (40-64) and elderly (over 65 years old) consumed majority of expenditure, and the age of female (45-54 years old) with peak of CCE of neoplasm was almost 15 years younger than male (60-64 years old). Additionally, for male, the top three neoplasms in terms of consuming CCE of neoplasm were stomach cancer, colorectal cancer and lung cancer, whereas that were uterine leiomyoma, breast cancer as well as cervix uteri cancer for female. The random forest regression model showed that the top 5 influential factors in the ranking of importance were the length of stay, operation, proportion of drug, neoplasms and institution level.Conclusions: SHA 2011 is a powerful tool to describe financial flow and to link expenditure to treatment of disease, and in aspect of treatment of neoplasm in underdeveloped region of China, the unreasonable financing scheme, unbalanced allocation of medical resource to heath provider, as well as the distinct distribution characteristics of beneficiaries’ expenditure should attract wide attention to policy maker.