Health care utilization for patients with stroke: a 3-year cross-sectional study of China’s two urban health insurance schemes across four cities

Qin

et al. 2022

JAHA

Background We aimed to evaluate the association between the Chinese visceral adiposity index (CVAI) and its dynamic change and risk of carotid plaque based on a large Chinese cohort. Methods and Results This cohort included 23 522 participants aged 20 to 80 years without elevated carotid intima‐media thickness and carotid plaque at baseline and who received at least 2 health checkups. CVAI was calculated at baseline and at every checkup. The dynamic change in CVAI was calculated by subtracting CVAI at baseline from that at the last follow‐up. Cox proportional hazard regression model was used to estimate hazard ratios (HRs) and 95% CIs. The restricted cubic spline was applied to model the dose‐response association between CVAI and carotid plaque risk. During the 82 621 person‐years of follow‐up, 5987 cases of carotid plaque developed (7.25/100 person‐years). We observed a significant positive correlation between CVAI and carotid plaque risk (HR, 1.53; 95% CI, 1.48–1.59 [ P <0.001]) in a nonlinear dose‐response pattern ( P nonlinearity <0.001). The sensitivity analyses further confirmed the robustness of the results. The association was significant in all subgroup analyses stratified by sex, hypertension, and fatty liver disease except for the diabetes subgroup. The association between CVAI and carotid plaque risk was much higher in men than in women. No significant association was identified between change in CVAI and carotid plaque risk. Conclusions CVAI was positively associated with carotid plaque risk in a nonlinear dose‐response pattern in this study. Individuals should keep their CVAI within a normal level to prevent the development of carotid plaque.

Section: Discussionmentioning

confidence: 99%

Association of Chinese Visceral Adiposity Index and Its Dynamic Change With Risk of Carotid Plaque in a Large Cohort in China

Qin

et al. 2022

JAHA

Int J Health Policy Manag

“… 41 NCMS, UEBMI and URBMI were China’s three basic social health insurance schemes, but differed in reimbursement ratios, coverage and contributions. 38 Previous research indicated that medical insurance was associated with the cost and adverse clinical outcomes of stroke, 10 , 42 - 44 therefore, we included the type of insurance in the analysis.…”

Section: Methodsmentioning

confidence: 99%

Length of Stay, Hospital Costs and Mortality Associated With Comorbidity According to the Charlson Comorbidity Index in Immobile Patients After Ischemic Stroke in China: A National Study

Liu

Song

Jin

et al. 2021

Background: In this study, we examined the length of stay (LoS)-predictive comorbidities, hospital costs-predictive comorbidities, and mortality-predictive comorbidities in immobile ischemic stroke (IS) patients; second, we used the Charlson Comorbidity Index (CCI) to assess the association between comorbidity and the LoS and hospitalization costs of stroke; third, we assessed the magnitude of excess IS mortality related to comorbidities. Methods: Between November 2015 and July 2017, 5114 patients hospitalized for IS in 25 general hospitals from six provinces in eastern, western, and central China were evaluated. LoS was the period from the date of admission to the date of discharge or date of death. Costs were collected from the hospital information system (HIS) after the enrolled patients were discharged or died in hospital. The HIS belongs to the hospital's financial system, which records all the expenses of the patient during the hospital stay. Cause of death was recorded in the HIS for 90 days after admission regardless of whether death occurred before or after discharge. Using the CCI, a comorbidity index was categorized as zero, one, two, and three or more CCI diseases. A generalized linear model with a gamma distribution and a log link was used to assess the association of LoS and hospital costs with the comorbidity index. Kaplan-Meier survival curves was used to examine overall survival rates. Results: We found that 55.2% of IS patients had a comorbidity. Prevalence of peripheral vascular disease (21.7%) and diabetes without end-organ damage (18.8%) were the major comorbidities. A high CCI=3+ score was an effective predictor of a high risk of longer LoS and death compared with a low CCI score; and CCI=2 score and CCI=3+ score were efficient predictors of a high risk of elevated hospital costs. Specifically, the most notable LoS-specific comorbidities, and cost-specific comorbidities was dementia, while the most notable mortality-specific comorbidities was moderate or severe renal disease. Conclusion: CCI has significant predictive value for clinical outcomes in IS. Due to population aging, the CCI should be used to identify, monitor and manage chronic comorbidities among immobile IS populations.

“…Thirdly, it was reported that UEBMI beneficiaries demanded more hospital services than they needed, and patients under the UEBMI scheme were more likely to use inpatient services than those covered by the URBMI scheme [ 65 ]. Fourthly, since different therapeutic schedules could be adopted by health providers according to patients’ insurance type, the UEBMI enrollees had a higher percentage of inpatients receiving expensive medications than the URBMI enrollees [ 31 , 66 ]. Therefore, the direct medical costs of patients with PD varied between these two health insurance schemes.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the predictors of inpatient costs for patients with PD were selected based on this theoretical framework [ 38 ] and the results of the literature review. Individual influential factors were selected from the following three parts: (1) predisposing characteristics: existing conditions that predispose individuals to health services utilization (such as gender [ 41 , 42 ] and age [ 28 , 30 , 43 , 44 , 45 , 46 , 47 ]); (2) enabling characteristics: conditions that facilitate or impede health services usage (for example, type of insurance [ 31 , 32 ]); (3) need characteristics: conditions that medical providers consider as requiring professional treatment (such as disease subtypes [ 35 , 37 ], hospital levels [ 34 , 48 ], length of stay (LOS) [ 35 , 48 ] and presence of any comorbidities [ 44 , 49 ]).…”

Section: Methodsmentioning

confidence: 99%

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Direct Medical Costs of Parkinson’s Disease in Southern China: A Cross-Sectional Study Based on Health Insurance Claims Data in Guangzhou City

Zhou

2022

IJERPH

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder. This study aims to evaluate the direct medical costs of patients with PD using a large sample from an entire city and to identity the potential factors correlating with their inpatient costs in Guangzhou City, Southern China. Methods: This retrospective cross-sectional study uses data obtained from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. The total sample was comprised of 2660 patients with PD. Costs were evaluated for the total sample and by types of insurance. The composition of costs was compared between the UEBMI and URBMI subgroups. The extended estimating-equations model was applied to identify the potential impact factors influencing the inpatient costs. Results: The direct medical costs per patient with PD were CNY 14,514.9 (USD 2299.4) in 2012, consisting of inpatient costs of CNY 13,551.4 and outpatient costs of CNY 963.5. The medication costs accounted for the largest part (50.3%). The inpatient costs of PD patients under the UEBMI scheme (CNY 13,651.0) were significantly higher than those of patients in the URBMI subgroup (CNY 12,402.2) (p < 0.05). The proportion of out-of-pocket spending out of inpatient and outpatient costs for UEBMI beneficiaries (24.3% and 56.1%) was much lower than that for patients under the URBMI scheme (47.9% and 76.2%). The regression analysis suggested that types of insurance, age, hospital levels, length of stay (LOS) and comorbidities were significantly correlated with the inpatient costs of patients with PD. Conclusions: The direct medical costs of patients with PD in China were high compared to the GDP per capita in Guangzhou City and different between the two evaluated types of insurance. Patients with the UEBMI scheme, of older age, with comorbidities, staying in tertiary hospitals and with longer LOS had significantly higher inpatient costs. Thus, policymakers need to reduce the gaps between the two urban insurance schemes in benefit levels, provide support for the development of a comprehensive long-term care insurance system and promote the use of telemedicine in China.