Role of Health Insurance in Averting Economic Hardship in Families After Acute Stroke in China
Role of Health Insurance in Averting Economic Hardship in Families After Acute Stroke in China
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DOI：
10.1161/strokeaha.108.540054
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发表时间：
2009-06-01
期刊：
影响因子：
8.3
通讯作者：
Wang, Jiguang
中科院分区：
文献类型：
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作者：
Heeley, Emma;Anderson, Craig S.;Wang, Jiguang
背景和目的-脑卒中是中国主要的健康负担，但其对家庭经济影响的数据有限。我们的目的是研究中风的经济影响，并评估健康保险的影响。方法，在全国范围内，前瞻性，62家医院登记研究急性中风在中国，我们记录了患者的人口统计学资料，临床特征，社会经济因素，管理和医疗费用。在3个月和12个月随访时，获得了存活患者的自付医疗费用信息。灾难性的医疗费用，定义为>= 30%的家庭年总收入，估计从报告的家庭annualincome.Results-Among 4739 3个月的幸存者中风的结果data，平均住院和药物治疗费用为16525中国元人民币（2361美元）和自付费用为14478中国元人民币（2068美元）。总体而言，3384例（71%）患者经历了灾难性的自付费用。没有健康保险的工人比有保险的工人更有可能经历灾难性的付款，其风险比为7倍（OR，6.9; 95%CI，4.6至10.3）。健康保险也保护了那些退休或不工作的患者免受灾难性的支付（无保险：OR，4.7; 95%CI，3.1至7.2; OR，1.82; 95%CI，1.3至2.6，分别）。健康保险保护家庭免受灾难性医疗费用的影响，从而凸显了加快中国城乡综合医疗体系建设的必要性。（中风。2009; 40：2149-2156）。
Background and Purpose-Stroke is a major health burden in China, but there are limited data on its economic effects on households. We aimed to examine the economic impact of stroke and to assess the influence of health insurance.Methods-In a nationwide, prospective, 62-hospital registry study of acute stroke in China, we recorded information on patient demographics, clinical features, socioeconomic factors, management, and costs of medical care. Information on out-of-pocket health expenses was obtained in surviving patients at 3- and 12-month follow-up. Catastrophic healthcare payments, defined as >= 30% of total household annual income, were estimated from reported household annual income.Results-Among 4739 3- month survivors of stroke with outcome data, average hospital and medication costs were 16 525 Chinese Yuan Renminbi (US $ 2361) and out-of-pocket costs were 14 478 Chinese Yuan Renminbi (US $ 2068). Overall, 3384 (71%) patients had experienced catastrophic out-of-pocket expenditure. Workers without health insurance were 7 times (OR, 6.9; 95% CI, 4.6 to 10.3) more likely to experience catastrophic payments than workers with insurance. Health insurance also protected against catastrophic payments in patients who were either retired or not working (no insurance: OR, 4.7; 95% CI, 3.1 to 7.2; OR, 1.82; 95% CI, 1.3 to 2.6, respectively).Conclusions-Because healthcare costs are high relative to income in China, families face considerable economic hardship after stroke. Health insurance protects families against catastrophic healthcare payments, thus highlighting the need to accelerate the ongoing process of building a comprehensive healthcare system in both urban and rural settings in China. (Stroke. 2009; 40: 2149-2156.)