Impact of Increased Economic Burden Due to Human Echinococcosis in an Underdeveloped Rural Community of the People's Republic of China

Background: Ningxia is located in western People's Republic of China, which is hyperendemic for human cystic echinococcosis (CE) throughout the entire area with alveolar echinococcosis (AE) hyperendemic in the south. This is in part due to its underdeveloped economy. Despite the recent rapid growth in P.R. China's economy, medical expenditure for hospitalization of echinococcosis cases has become one of the major poverty generators in rural Ningxia, resulting in a significant social problem. Methodology/Principal Findings: We reviewed the 2000 inpatient records with liver CE in surgical departments of hospitals from north, central and south Ningxia for the period 1996–2002. We carried out an analysis of health care expenditure of inpatient treatment in public hospitals, and examined the financial inequalities relating to human echinococcosis and the variation in per capita income between various socioeconomic groups with different levels of gross domestic product for different years. Hospital charges for Yinchuan, NHAR's capital city in the north, increased approximately 35-fold more than the annual income of rural farmers with the result that they preferred to seek health care in local county hospitals, despite higher quality and more efficient treatment and diagnosis available in the city. Household income levels thus strongly influenced the choice of health care provider and the additional expense impeded access of poor people to better quality treatment. Conclusions/Significance: Information on socioeconomic problems arising from echinococcosis, which adds considerably to the burden on patient families and communities, needs to be collected as a prerequisite for developing policies to tackle the disease in rural Ningxia. Author Summary: This paper compares medical expenditure for hospital treatment of echinococcosis in NHAR, western People's Republic of China, for different years, different regions and different socioeconomic groups. The results show that the level of household income strongly influences health care decisions. This study represents an effort to determine the effect of hospital charges for inpatient treatment of echinococcosis on the choice of provider in NHAR, and quantitatively examines this topic for the rural poor. The findings show that low income individuals from rural areas opted to visit a local county hospital rather than an urban hospital for hydatid surgery despite the inferior infrastructure, personnel and general health care facilities available. There are a number of policy implications. For example, enhancing the quality and service of county hospitals in rural areas will benefit those with lower incomes, thus improving access of rural residents to health facilities for higher quality diagnosis and efficient treatment. Thus, we advocate that government policy should be to increase investment in health care in poor rural areas, and to launch relevant medical aid projects to help those in poverty.