In recent years, the incidence and mortality of cancer have witnessed a dramatic increase. Cancer has already caused severe economic burdens on society, especially in developing countries and has become a major public health concern. This study evaluates the medical economic burden, including total current curative expenditure (CCE) and catastrophic health expenditure (CHE) on cancer in Liaoning Province, China. A total of 252 medical institutions were investigated with multistage stratified cluster random sampling. We established a standardized database of 3 532 517 samples. “System of Health Account 2011”, a new internationally recognized accounting system, was established to analyze the CCE on six most common cancers. CHE were estimated from the extracted 1344 patients with cancer, which performed a cross‐sectional study. The association of individual and contextual factors with CHE was evaluated using logistic regression models. CCE for all the patients with the six types of cancer was 2801.38 million CNY in Liaoning Province, the highest of which was lung cancer. The incidence of CHE was 42.78%, while the threshold was 40%. The average and relative distance were 10.41% and 24.32%, respectively. Influencing factors were length of stay, type of health insurance, location of household, etc. Our findings highlight the need to address medical economic burden in the cancer population. Households with the cancer are more likely to incur CHE. Financial intervention to prevent it should target on poor households. We provide suggestions in aspects of health insurance and health service management to reduce CHE.

BackgroundThe aging of population and the burden of disease among the aged have become one of the hot topics in the international health, and also brought tremendous pressure in the development of health service.MethodsA total of 1,377,681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and “System of Health Account 2011” was conducted to analyze the expenditure of disease for the elderly. Influencing factors were performed using multiple stepwise regression analysis.ResultsThe curative care expenditure for the aged was 233.18 billion RMB. Most of the expenditure for the old people was in hospital. Moreover, by the disease, the highest expenditure was incurred by non-communicable diseases. The financing scheme of the aged was concentrated on social health insurance and family health expenditure. Hospitalization expenditure was significantly associated with length of stay, operation, etc.ConclusionsThis study intends to capture large data from various medical institutions with a new accounting system. The finding illustrates that the burden of old people is still heavy.

BackgroundSystem of Health Accounts 2011 (SHA 2011) is a new health care accounts system, revised from SHA 1.0 by the Organisation for Economic Co-operation and Development (OECD), the World Health Organization (WHO) and Eurostat. It keeps the former tri-axial relationship and develops three analytical interfaces, in order to fix the existing shortcomings and make it more convenient for analysis and comparison across countries. SHA 2011 was introduced in China in 2014, and little about its application in China has been reported. This study takes children as an example to study how to apply SHA 2011 at the subnational level in the practical situation of China’s health system.MethodsMultistage random sampling method was applied and 3 532 517 samples from 252 institutions were included in the study. Official yearbooks and account reports helped the estimation of provincial data. The formula to calculate Current Health Expenditure (CHE) was introduced step-by-step. STATA 10.0 was used for statistics.ResultsUnder the frame of SHA 2011, the CHE for children in Liaoning was calculated as US$ 0.74 billion in 2014; 98.56% of the expenditure was spent in hospital and the allocation to primary health care institutions was insufficient. Infection, maternal and prenatal diseases cost the most in terms of Global Burden of Disease (GBD), and respiratory system diseases took the leading place in terms of International Classification of Disease Tenth Revision (ICD-10). In addition, medical income contributed most to the health financing.ConclusionsThe method to apply SHA 2011 at the subnational level is feasible in China. It makes health accounts more adaptable to rapidly developing health systems and makes the financing data more readily available for analytical use. SHA 2011 is a better health expenditure accounts system to reveal the actual burden on residents and deserves further promotion in China as well as around the world.

BackgroundHospitalization expenditure of genitourinary system diseases among the aged is often overlooked. The aim of our research is to analyze the basic situation and influencing factors of hospitalization expenditure of the genitourinary system diseases and provide better data for the health system.MethodsA total of 1 377 681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and “System of Health Account 2011” (SHA2011) was conducted to analyze the expenditure of the diseases. The corresponding samples were extracted, the neural network model was utilized to fit the regression model of the diseases among the aged, and sensitivity analysis was used to rank the influencing factors.ResultsTotal hospitalization expenditure in Liaoning was 51.286 billion yuan, and curative care expenditure of diseases of the genitourinary system was 3.350 billion yuan, accounting for 6.53%. In the neural network model, the training set of R2 was 0.71. The test set of R2 was 0.74. In the sensitivity analysis, top-three influencing factors were the length of stay, type of institutions and type of insurances; the weight was 0.28, 0.19 and 0.14, respectively.ConclusionsThis research used SHA2011 to grab a large amount of data and analyzed them depending upon the corresponding dimensions. The neural network can analyze the influencing factors of hospitalization expenditure of genitourinary diseases in elderly patients accurately and directly, and can clearly describe the extent of its impact by combining sensitivity analysis.

Background Population ageing and the economic burden of aged disease have become topical issues in global health. The situation seems worse in China, which has 140 million people older than 65 years. We analysed the medical economic burden in Liaoning Province, China, and laid stress on the population aged 65 years and older. MethodsWe used a multistage random sampling method for selecting 252 medical institutions from four cities, Panjin, Tieling, Dalian, and Liaoyang, in Liaoning Province. We established a standardised database for medical expense between Jan 1, 2014, and Dec 31, 2014, using a new internationally recognised accounting system, System of Health Accounts 2011 (SHA2011). We classifi ed expenses by disease based on ICD-10 and compared per-capita medical expense between age groups. We used SPSS22·0 and STATA12·0 to analyse the medical economic burden. The study was approved by Medical Ethics Committee of China Medical University and all patients' information was collected with written informed consents.Findings We obtained medical expense data for the year of 2014 from 252 institutions, including data for 3 532 517 patients. Circulation system disease (32·10%, 95% CI 32·05-32·15) and digestive system disease (11·56%, 11·54-11·58) constituted nearly half of the medical expenses. Among the population aged older than 65 years, cardiovascular disease (31·39%, 31·35-31·43), respiratory diseases (27·83%, 27·79-27·8), and digestive diseases (23·56%, 23·52-23·60) were the major burden. The aged population constituted 11·52% (4·88 million) of total Liaoning population, but spent 29·71% (95% CI 29·69-29·7) of the medical expenses. The per capita medical expense of the aged population (US$520·86, CNY 3 199 52) was nearly three times that of those aged 14-65 years ($163·45, CNY 1 004·04) and four times that of those aged 0-14 years ($139·02, CNY 853·96).Interpretation Cardiovascular diseases bring the heaviest medical economic burden, but the rise in respiratory and digestive diseases among the aged population deserves attention. The aged diseases cost a large proportion of medical expenses. This study raises advanced counting models and control strategies on medical expenses. More researches in other provinces are ongoing and will be discussed later. Abstract with input from WD. XM helped revise the Abstract. All authors have seen and approved the fi nal version of the Abstract for publication.