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Fang Q, Ma G, Wang Y, Wei J, Zhang Q, Xu X, Wang X. Current curative expenditure of non-communicable diseases changed in Dalian, China from 2017 to 2019: a study based on 'System of Health Accounts 2011'. BMJ Open 2022; 12:e056900. [PMID: 35365532 PMCID: PMC8977744 DOI: 10.1136/bmjopen-2021-056900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To analyse the current curative expenditure (CCE) of NCDs in China from 2017 to 2019. DESIGN A cross-sectional study. Medical institutions were collected by multistage stratified random sampling from 2017 to 2019. SETTING Dalian, China PARTICIPANTS: 408 institutions and 8 104 233 valid items were included in the study. NCDs patients were selected according to International Classification of Diseases-10. PRIMARY AND SECONDARY OUTCOME MEASURES CCE for NCDs was measured based on the System of Health Accounts 2011. Influenced factors were analysed by linear regression. All analyses and calculations were performed by STATA V.15.0. RESULTS The CCE of NCDs was ¥14.929 billion in 2017, ¥16.377 billion in 2018 and ¥18.055 billion in 2019, which accounted for more than 65% of total expenditure spent each year. More than 60% came from public financing. The proportion of family health financing continued to decline, reaching 31.16% in 2019. The expenditures were mainly in general hospitals, above 70%. Elderly patients account for the majority. Diseases of the circulatory system, diseases of the digestive system and neoplasms were the main NCDs. Year, age, gender, length of stay, surgery, insurance and institution level affected hospitalisation expenses. CONCLUSIONS NCDs are the main CCE of diseases in China, and their resources are not allocated reasonably. To reduce the CCE of NCDs, the government needs to optimise resource allocation and rationalise institutional flows and functions.
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Affiliation(s)
- Quan Fang
- College of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Guoliang Ma
- College of Health Management, China Medical University, Shenyang, Liaoning, China
- Executive Office, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yuhang Wang
- Finance Section, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jingjing Wei
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qin Zhang
- College of Health Management, China Medical University, Shenyang, Liaoning, China
- Finance Section, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xinzhou Xu
- College of Health Management, China Medical University, Shenyang, Liaoning, China
- Medical Department, Nanjing Medical University Affiliated Wuxi No.2 People's Hospital, Wuxi, Jiangsu, China
| | - Xin Wang
- College of Health Management, China Medical University, Shenyang, Liaoning, China
- Research Center for Health Development - Liaoning New Type Think Tank for University, China Medical University, Shenyang, Liaoning, China
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Zang S, Zhao M, Zhu Y, Zhang Y, Chen Y, Wang X. Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China's universal two-child policy enactment: a population-based retrospective study. BMJ Open 2022; 12:e054037. [PMID: 35260454 PMCID: PMC8905967 DOI: 10.1136/bmjopen-2021-054037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To describe and explore women's medical expenditures during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy enactment in China. DESIGN Population-based retrospective study. SETTING Dalian, China. PARTICIPANTS Under the System of Health Accounts 2011 framework, the macroscopic dataset was obtained from the annual report at the provincial and municipal levels in China. The research sample incorporated 65 535 inpatient and outpatient records matching International Classification of Diseases, 10th Revision codes O00-O99 in Dalian city from 2015 through 2017. PRIMARY AND SECONDARY OUTCOME MEASURES The study delineates women's current curative expenditure (CCE) during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy in China. The temporal changes of medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China's universal two-child policy enactment were assessed. The generalised linear model and structural equation model were used to test the association between medical expenditure and study variables. RESULTS Unlike the inverted V-shaped trend in the number of live newborns in Dalian over the 3 studied years, CCE on pregnancy, childbirth and puerperium dipped slightly in 2016 (¥260.29 million) from 2015 (¥263.28 million) and saw a surge in 2017 (¥288.65 million). The ratio of out-of-pocket payment/CCE reduced year by year. There was a rapid increase in CCE in women older than 35 years since 2016. Length of stay mediated the relationship between hospital level, year, age, reimbursement ratio and medical expenditure. CONCLUSIONS The rise in CCE on pregnancy, delivery and puerperium lagged 1 year behind the surge of newborns at the beginning of China's universal two-child policy. Length of stay acted as a crucial mediator driving up maternal medical expenditure. Reducing medical expenditure by shortening the length of stay could be a feasible way to effectively address the issue of cost in women during pregnancy, childbirth and puerperium.
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Affiliation(s)
- Shuang Zang
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Meizhen Zhao
- Nursing Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yalan Zhu
- College of Health Management, Research Center for Health Development-Liaoning New Type Think Tank for University, China Medical University, Shenyang, Liaoning, China
| | - Ying Zhang
- School of Public Health, Dalian Medical University, Dalian, Liaoning, China
| | - Yu Chen
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Xin Wang
- College of Health Management, Research Center for Health Development-Liaoning New Type Think Tank for University, China Medical University, Shenyang, Liaoning, China
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Johnston BM, Burke S, Barry S, Normand C, Ní Fhallúin M, Thomas S. Private health expenditure in Ireland: Assessing the affordability of private financing of health care. Health Policy 2019; 123:963-969. [PMID: 31421910 DOI: 10.1016/j.healthpol.2019.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/19/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
This paper investigates the affordability of private health expenditure among Irish households and the services contributing towards financial hardship. We use data from the Irish Household Budget Survey, a representative survey of household spending in Ireland, covering 2009-10 and 2015-16. Private health expenditure comprises out-of-pocket payments for health and social care services and private health insurance (PHI) premiums. The poverty threshold is 60% of median total equivalised consumption and households with consumption below this level were defined as poor. Households were classified as having unaffordable health expenditure if: 1) they were poor and reported any spending; 2) they were pushed below poverty threshold by health spending; or 3) their spending on health exceeded 40% of capacity to pay. Despite signs of economic recovery, the incidence of unaffordable private health spending increased over the years-from 15% in 2009-10 to 18.8% in 2015-16. People on low incomes were disproportionately affected. The largest component of unaffordable spending for poorer households is PHI and not user charges, which have actually fallen as a cause of hardship. Our findings indicate that reliance on private health expenditure as a funding mechanism undermines the fundamental goals of equity and appropriate access within the health care system.
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Affiliation(s)
- Bridget M Johnston
- Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin 2, Ireland.
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin 2, Ireland
| | - Sarah Barry
- Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin 2, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin 2, Ireland
| | - Maebh Ní Fhallúin
- Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin 2, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, 2-4 Foster Place, Dublin 2, Ireland
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Li M, Zheng A, Duan W, Mu X, Liu C, Yang Y, Wang X. How to apply SHA 2011 at a subnational level in China's practical situation: take children health expenditure as an example. J Glob Health 2018; 8:010801. [PMID: 29862027 PMCID: PMC5935427 DOI: 10.7189/jogh.08.010801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background System 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. Methods Multistage 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. Results Under 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. Conclusions The 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.
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Affiliation(s)
- Mingyang Li
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.,Joint first authorship
| | - Ang Zheng
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.,Joint first authorship
| | - Wenjuan Duan
- Department of Humanities and Social Sciences, China Medical University, Shenyang, China
| | - Xin Mu
- Department of Humanities and Social Sciences, China Medical University, Shenyang, China
| | - Chunli Liu
- Library of China Medical University, Shenyang, China
| | - Yang Yang
- Department of Fundamental Sciences, China Medical University, Shenyang, China
| | - Xin Wang
- Department of Humanities and Social Sciences, China Medical University, Shenyang, China
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Loughnane C, Murphy A, Mulcahy M, McInerney C, Walshe V. Have bailouts shifted the burden of paying for healthcare from the state onto individuals? Ir J Med Sci 2018; 188:5-12. [PMID: 29633161 DOI: 10.1007/s11845-018-1798-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/19/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND/AIMS The financial crisis that enveloped Europe in 2009 created financial pressure for governments and required a number of countries to obtain a financial bailout from the IMF. The purpose of this paper is to examine the effect of the financial crisis on public health expenditure in bailout countries and if bailouts shift the burden of paying for healthcare from the state onto individuals. METHODS Quantitative health expenditure data were collected from the WHO and OECD for the period 2004-2015 and evaluated using a comparison of means Welch's t test. RESULTS The majority of bailout countries recorded a decrease in public health expenditure as a percentage of total government expenditure, with Ireland recording the largest decrease with government health expenditure as a percentage of total government expenditure, falling by 22% (P < .01). In addition, the results also suggest that the burden of paying for healthcare shifted from the state onto individuals in three countries, namely Hungary, Ireland and Portugal, where public health expenditure declined and private expenditure increased significantly. CONCLUSIONS The ramifications of shifting the burden of paying for healthcare from the state onto individuals at this point remain unclear with further research required to identify the long-term consequences for healthcare.
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Affiliation(s)
- Conor Loughnane
- Cork University Business School, University College Cork, Cork, Ireland.
| | - Aileen Murphy
- Cork University Business School, University College Cork, Cork, Ireland
| | - Mark Mulcahy
- Cork University Business School, University College Cork, Cork, Ireland
| | - Celine McInerney
- Cork University Business School, University College Cork, Cork, Ireland
| | - Valerie Walshe
- Health Service Executive, Model Business Park, Model Farm Road, Cork, Ireland
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Affiliation(s)
- Brian Turner
- University College Cork, Cork T12 YN60, Ireland.
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Keegan C, Connolly S, Wren MA. Measuring healthcare expenditure: different methods, different results. Ir J Med Sci 2017; 187:13-23. [DOI: 10.1007/s11845-017-1623-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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