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

Abstract

Background Stroke is a devastating disease and a major cause of death and disability worldwide. We evaluated differences in stroke patients’ health care utilization by insurance type across four cities in China. Methods The data were a 5% random sampling from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) from 2014 to 2016. The descriptive analyze and interaction actions were mainly conducted. Results We found that differences in healthcare utilization and medical expenses varied more across the four cities, Beijing, Shanghai, Tianjin, and Chongqing, than they did between the UEBMI and URBMI scheme. On average, UEBMI patients had a significantly larger number of outpatient (4.3) and inpatient (1.4) visits per year than the URBMI group (2.0 outpatient and 1.1 inpatient visits per year). UEBMI members’ average length of stay (ALOS) of 18.3 days was significantly longer than the 11 days ALOS of URBMI members. Importantly, the significant differences in healthcare utilization and healthcare expenditures were greater between cities than the average differences between UEBMI and URBMI. Beijing UEBMI outpatient (5.0) and inpatient (1.4) visits and Shanghai UEBMI outpatient (4.8) and inpatient (1.7) visits were significantly higher than Tianjin (3.4 outpatient and 1.4 inpatient visits) and Chongqing (1.8 outpatient and 1.1 inpatient visits). The divergences of UEBMI visits across the four cities were greater than the average UEBMI outpatient (4.3) and inpatient (1.4) visits. ALOS for URBMI Beijing patients (14.8 days) and Shanghai patients (27.7 days) were significantly longer than Tianjin (10.2 days) and Chongqing (10.1 days) URBMI patients. Medical costs, total OOP expenses and OOP reimbursement rates also varied more across the four cities than the average UEBMI or URBMI medical costs, total OOP expenses and reimbursement rates. Conclusions The health care utilization of patients with stroke varied by insurance type and city, and the differences in utilization and health care costs across cities was greater than the average difference between UEBMI and URBMI. Launching a new critical illness insurance scheme and further reforming the UEBMI and URBMI schemes would reduce these inter-city differences in health care utilization.