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Variations and Determinants of Hospital Costs for Acute Stroke in China

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Listed:
  • Jade W Wei
  • Emma L Heeley
  • Stephen Jan
  • Yining Huang
  • Qifang Huang
  • Ji-Guang Wang
  • Yan Cheng
  • En Xu
  • Qidong Yang
  • Craig S Anderson
  • for the ChinaQUEST Investigators

Abstract

Background: The burden of stroke is high and increasing in China. We modelled variations in, and predictors of, the costs of hospital care for patients with acute stroke in China. Methods and Findings: Baseline characteristics and hospital costs for 5,255 patients were collected using the prospective register-based ChinaQUEST study, conducted in 48 Level 3 and 14 Level 2 hospitals in China during 2006–2007. Ordinary least squares estimation was used to determine factors associated with hospital costs. Overall mean cost of hospitalisation was 11,216 Chinese Yuan Renminbi (CNY) (≈US$1,602) per patient, which equates to more than half the average annual wage in China. Variations in cost were largely attributable to stroke severity and length of hospital stay (LOS). Model forecasts showed that reducing LOS from the mean of 20 days for Level 3 and 18 days for Level 2 hospitals to a duration of 1 week, which is common among Western countries, afforded cost reductions of 49% and 19%, respectively. Other lesser determinants varied by hospital level: in Level 3 hospitals, health insurance and the occurrence of in-hospital complications were each associated with 10% and 18% increases in cost, respectively, whilst treatment in a teaching hospital was associated with approximately 39% decrease in cost on average. For Level 2 hospitals, stroke due to intracerebral haemorrhage was associated with a 19% greater cost than for ischaemic stroke. Conclusions: Changes to hospital policies to standardise resource use and reduce the variation in LOS could attenuate costs and improve efficiencies for acute stroke management in China. The success of these strategies will be enhanced by broader policy initiatives currently underway to reform hospital reimbursement systems.

Suggested Citation

  • Jade W Wei & Emma L Heeley & Stephen Jan & Yining Huang & Qifang Huang & Ji-Guang Wang & Yan Cheng & En Xu & Qidong Yang & Craig S Anderson & for the ChinaQUEST Investigators, 2010. "Variations and Determinants of Hospital Costs for Acute Stroke in China," PLOS ONE, Public Library of Science, vol. 5(9), pages 1-9, September.
    • Handle: RePEc:plo:pone00:0013041
    DOI: 10.1371/journal.pone.0013041
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    as
    1. Zizza, C. & Herring, A.H. & Stevens, J. & Popkin, B.M., 2004. "Length of hospital stays among obese individuals," American Journal of Public Health, American Public Health Association, vol. 94(9), pages 1587-1591.
    2. Meng, Qingyue & Rehnberg, Clas & Zhuang, Ning & Bian, Ying & Tomson, Goran & Tang, Shenglan, 2004. "The impact of urban health insurance reform on hospital charges: a case study from two cities in China," Health Policy, Elsevier, vol. 68(2), pages 197-209, May.
    3. Evers, Silvia & Voss, Gemma & Nieman, Fred & Ament, Andre & Groot, Tom & Lodder, Jan & Boreas, Anita & Blaauw, Gerhard, 2002. "Predicting the cost of hospital stay for stroke patients: the use of diagnosis related groups," Health Policy, Elsevier, vol. 61(1), pages 21-42, July.
    4. Hong Wang & Winnie Yip & Licheng Zhang & William C. Hsiao, 2009. "The impact of rural mutual health care on health status: evaluation of a social experiment in rural China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 65-82, July.
    5. Tu, Feng & Anan, Makoto & Kiyohara, Yutaka & Okada, Yasushi & Nobutomo, Koichi, 2003. "Analysis of hospital charges for ischemic stroke in Fukuoka, Japan," Health Policy, Elsevier, vol. 66(3), pages 239-246, December.
    6. Yoneda, Yukihiro & Okuda, Satoshi & Hamada, Rikuzo & Toyota, Akihiro & Gotoh, Jun & Watanabe, Manabu & Okada, Yasushi & Ikeda, Kiyonobu & Ibayashi, Setsuro & Hasegawa, Yasuhiro, 2005. "Hospital cost of ischemic stroke and intracerebral hemorrhage in Japanese stroke centers," Health Policy, Elsevier, vol. 73(2), pages 202-211, August.
    7. Tu, Feng & Tokunaga, Shoji & Deng, ZhouLu & Nobutomo, Koichi, 2002. "Analysis of hospital charges for cerebral infarction stroke inpatients in Beijing, People's Republic of China," Health Policy, Elsevier, vol. 59(3), pages 243-256, March.
    8. Mitchell A. Petersen, 2009. "Estimating Standard Errors in Finance Panel Data Sets: Comparing Approaches," Review of Financial Studies, Society for Financial Studies, vol. 22(1), pages 435-480, January.
    9. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
    10. Liu, Gordon G. & Zhao, Zhongyun & Cai, Renhua & Yamada, Tetsuji & Yamada, Tadashi, 2002. "Equity in health care access to: assessing the urban health insurance reform in China," Social Science & Medicine, Elsevier, vol. 55(10), pages 1779-1794, November.
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    3. Małgorzata Cygańska & Magdalena Kludacz-Alessandri & Chris Pyke, 2023. "Healthcare Costs and Health Status: Insights from the SHARE Survey," IJERPH, MDPI, vol. 20(2), pages 1-14, January.
    4. Hui Zhang & Donglan Zhang & Yujie Yin & Chao Zhang & Yixiang Huang, 2019. "Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City," IJERPH, MDPI, vol. 16(15), pages 1-18, August.

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