Introduction
Materials and methods
Data source
UEBMI | URBMI | |||||
---|---|---|---|---|---|---|
Inception year | 2002 | 2008 | ||||
Eligible population | Urban employed (employees; retirees) | Urban non-employed (children and full-time students; unemployed adults; elderly residents not covered by the UEBMI scheme) | ||||
Sources of funding | The employers contribute 6% of the employee’s salary whilst the employees contribute 2% Retirees are exempt from premium contribution | Government subsidy (70%) and individual premium (30%) CNY440 to CNY1800 per person per year for residents (including government subsidy) | ||||
Accounts | Medical savings account (including employee contributions and 30% of employer contributions) for outpatient care; social risk-pooling account (70% of employer contributions) for inpatient care and critical (i.e. chronic or fatal diseases including schizophrenia) outpatient care | Social risking-pooling account (all funds) for inpatient care and critical (i.e. chronic or fatal diseases including schizophrenia) outpatient care | ||||
Service package | Comprehensive | Limited | ||||
Inpatient
|
Inpatient
| |||||
Benefit packages of social risk-pooling account | Employees | Primary hospitals | 90% | Children and students | Primary hospitals | 85% |
Secondary hospitals | 85% | Secondary hospitals | 75% | |||
Tertiary hospitals | 80% | Tertiary hospitals | 65% | |||
Reimbursement rate (Inpatient care) | Retirees | Primary hospitals | 93% | Unemployed adults and elderly residents | Primary hospitals | 85% |
Secondary hospitals | 89.5% | Secondary hospitals | 70% | |||
Tertiary hospitals | 86% | Tertiary hospitals | 55% | |||
Reimbursed ceiling (Inpatient care) | Six times of local employees’ annual average wage per year (CNY445,470) | Six times of local household disposable income per year (CNY228,324) | ||||
Critical outpatient
|
Critical outpatient
| |||||
Reimbursement rate (Outpatient care) | Community health centers | 85% | Community health centers | 70% | ||
Non-community institutes | 65% | Non-community institutes | 50% | |||
Reimbursed ceiling (Outpatient care) | CNY150 per person per month | CNY100 per person per month |
Study design
Cost estimation
Statistical analysis
Results
Patient characteristics
Baseline (2010.11.01–2011.10.31) | Overall | UEBMI | URBMI |
---|---|---|---|
No. patients | n = 2971 | n = 1760 | n = 1211 |
Gender | |||
Female | 1170.0 (39.4) | 736.0 (41.8) | 434.0 (35.8) |
Male | 1801.0 (60.6) | 1024.0 (58.2) | 777.0 (64.2) |
Age (years) | |||
Mean ± SD | 50.3 ± 12.7 | 52.4 ± 11.8 | 47.3 ± 13.5 |
Age group | |||
18 ≤ age < 30 | 187.0 (6.3) | 66.0 (3.8) | 121.0 (10.0) |
30 ≤ age < 40 | 379.0 (12.8) | 168.0 (9.5) | 211.0 (17.4) |
40 ≤ age < 50 | 847.0 (28.5) | 445.0 (25.3) | 402.0 (33.2) |
50 ≤ age < 60 | 887.0 (29.9) | 625.0 (35.5) | 262.0 (21.6) |
≥ 60 | 671.0 (22.6) | 456.0 (25.9) | 215.0 (17.8) |
Hospital level | |||
Primary | 76.0 (2.6) | 45.0 (2.6) | 31.0 (2.6) |
Secondary | 905.0 (30.5) | 517.0 (29.4) | 388.0 (32.0) |
Tertiary | 1990.0 (67.0) | 1198.0 (68.1) | 792.0 (65.4) |
Length of stay (days) | |||
Mean ± SD | 254.7 ± 135.1 | 244.9 ± 137.9 | 268.9 ± 129.8 |
Days ≤ 100 | 737.0 (24.8) | 482.0 (27.4) | 255.0 (21.1) |
100 < days ≤ 300 | 501.0 (16.9) | 315.0 (17.9) | 186.0 (15.4) |
> 300 days | 1733.0 (58.3) | 963.0 (54.7) | 770.0 (63.6) |
Follow-up no. patients | |||
First year (2011.11.01–2012.10.31) | 2021 | 1145 | 876 |
Second year (2012.11.01–2013.10.31) | 1901 | 1079 | 822 |
Third year (2013.11.01–2014.10.31) | 1754 | 988 | 766 |
Annual total medical costs of schizophrenia
Baseline | Overall | UEBMI | URBMI | P-value |
---|---|---|---|---|
n = 2971 | n = 1760 | n = 1211 | ||
Total costs | ||||
Mean (CNY) | 41,972.4 | 42,543.1 | 41,143.0 | 0.021 |
SD (CNY) | 22,741.3 | 24,250.8 | 20,330.0 | |
Out-of-pocket (%) | 13.0% | 12.7% | 13.5% | |
Inpatient costs | n = 2971 | n = 1760 | n = 1211 | |
Mean (CNY) | 41,780.9 | 42,375.1 | 40,917.3 | 0.018 |
SD (CNY) | 22,909.3 | 24,390.3 | 20,547.0 | |
Out-of-pocket (%) | 14.3% | 14.0% | 14.7% | |
Reimbursement (%) | 76.1% | 85.8% | 61.5% | |
Aid (%) | 9.6% | 0.2% | 23.8% | |
Outpatient costs | n = 329 | n = 216 | n = 113 | |
Mean (CNY) | 191.5 | 168.0 | 225.7 | 0.031 |
SD (CNY) | 747.5 | 607.2 | 913.0 | |
Out-of-pocket (%) | 63.6% | 53.9% | 74.1% | |
Reimbursement (%) | 36.4% | 46.1% | 25.9% |
Follow-up: first year | Overall | UEBMI | URBMI | P-value |
---|---|---|---|---|
n = 2021 | n = 1145 | n = 876 | ||
Total costs | ||||
Mean (CNY) | 55,934.5 | 57,369.7 | 54,058.6 | < 0.001 |
SD (CNY) | 19,779.9 | 21,320.6 | 17,397.7 | |
Out-of-pocket (%) | 12.3% | 10.7% | 14.5% | |
Inpatient costs | n = 2021 | n = 1145 | n = 876 | |
Mean (CNY) | 55,887.6 | 57,332.8 | 53,998.5 | < 0.001 |
SD (CNY) | 19,851.0 | 21,376.4 | 17,492.4 | |
Out-of-pocket (%) | 12.9% | 11.2% | 15.2% | |
Reimbursement (%) | 77.6% | 88.8% | 62.1% | |
Aid (%) | 9.5% | 0.0% | 22.7% | |
Outpatient costs | n = 69 | n = 41 | n = 28 | |
Mean (CNY) | 47.0 | 36.9 | 60.1 | 0.676 |
SD (CNY) | 339.7 | 273.3 | 410.5 | |
Out-of-pocket (%) | 67.0% | 55.5% | 76.4% | |
Reimbursement (%) | 32.9% | 44.6% | 23.6% |
Follow-up: second year | Overall | UEBMI | URBMI | P-value |
---|---|---|---|---|
n = 1901 | n = 1079 | n = 822 | ||
Total costs | ||||
Mean (CNY) | 55,778.4 | 57,326.6 | 53,746.0 | < 0.001 |
SD (CNY) | 18,646.0 | 20,107.1 | 16,323.7 | |
Out-of-pocket (%) | 8.7% | 10.7% | 5.9% | |
Inpatient costs | n = 1901 | n = 1079 | n = 822 | |
Mean (CNY) | 55,732.3 | 57,287.6 | 53,690.7 | < 0.001 |
SD (CNY) | 18,725.5 | 20,178.4 | 16,416.4 | |
Out-of-pocket (%) | 8.7% | 10.7% | 5.9% | |
Reimbursement (%) | 77.7% | 88.9% | 62.1% | |
Aid (%) | 13.6% | 0.4% | 32.0% | |
Outpatient costs | n = 44 | n = 22 | n = 22 | |
Mean (CNY) | 46.1 | 39.0 | 55.3 | 0.356 |
SD (CNY) | 379.8 | 360.5 | 403.8 | |
Out-of-pocket (%) | 68.6% | 58.1% | 78.4% | |
Reimbursement (%) | 31.3% | 41.9% | 21.6% |
Follow-up: third year | Overall | UEBMI | URBMI | P-value |
---|---|---|---|---|
n = 1754 | n = 988 | n = 766 | ||
Total costs | ||||
Mean (CNY) | 56,544.1 | 60,163.7 | 51,875.6 | < 0.001 |
SD (CNY) | 21,283.6 | 22,155.4 | 19,130.6 | |
Out-of-pocket (%) | 8.2% | 9.5% | 6.1% | |
Inpatient costs (n = 1229) | n = 1754 | n = 988 | n = 766 | |
Mean (CNY) | 56,502.7 | 60,145.2 | 51,804.5 | < 0.001 |
SD (CNY) | 21,346.2 | 22,195.0 | 19,218.0 | |
Out-of-pocket (%) | 8.1% | 9.5% | 6.0% | |
Reimbursement (%) | 77.6% | 88.1% | 61.9% | |
Aid (%) | 14.3% | 2.4% | 32.1% | |
Outpatient costs | n = 34 | n = 14 | n = 20 | |
Mean (CNY) | 41.4 | 18.4 | 71.1 | 0.069 |
SD (CNY) | 480.4 | 273.5 | 656.4 | |
Out-of-pocket (%) | 76.6% | 57.4% | 83.0% | |
Reimbursement (%) | 23.4% | 42.8% | 17.0% |
Differences in patients who used inpatient care only and patients who used both inpatient and outpatient care
Patients used inpatient only | Patients used both inpatient and outpatient | P-value | |||
---|---|---|---|---|---|
Mean | SD | Mean | SD | ||
No. patients | n = 2642 | n = 329 | |||
Baseline (2010.11.01–2011.10.31) | |||||
Gender | < 0.001 | ||||
Female | 40,992.4 | 23,387.4 | 24,797.1 | 16,566.3 | |
Male | 46,079.8 | 21,526.8 | 24,259.4 | 18,365.0 | |
Age groups | < 0.001 | ||||
18 ≤ age < 30 | 27,167.2 | 19,908.5 | 24,077.3 | 15,037.8 | |
30 ≤ age < 40 | 33,455.6 | 23,017.7 | 25,398.3 | 16,929.5 | |
40 ≤ age < 50 | 41,022.2 | 21,823.5 | 21,080.3 | 15,245.2 | |
50 ≤ age < 60 | 48,486.4 | 21,277.6 | 26,077.1 | 19,335.1 | |
≥ 60 | 51,116.8 | 20,017.9 | 33,827.1 | 22,827.8 | |
Insurance types | < 0.001 | ||||
UEBMI | 44,956.4 | 23,994.1 | 25,292.3 | 18,410.2 | |
URBMI | 43,002.9 | 19,858.8 | 23,070.2 | 15,460.2 | |
Hospital levels | < 0.001 | ||||
Primary | 19,764.9 | 15,675.1 | 7008.4 | 4565.4 | |
Secondary | 32,083.2 | 16,919.9 | 18,638.6 | 12,948.4 | |
Tertiary | 51,104.2 | 21,765.7 | 26,117.8 | 17,952.6 | |
Length of stay (days) | < 0.001 | ||||
Days ≤ 100 | 10,540.1 | 7063.1 | 13,868.6 | 7311.2 | |
100 < days ≤ 300 | 33,104.6 | 14,617.7 | 37,037.8 | 13,515.9 | |
> 300 days | 57,186.9 | 12,403.7 | 65,797.7 | 15,486.6 | |
Composition of inpatient costs | < 0.001 | ||||
Laboratory and diagnostic costs | 5537.7 | 7175.2 | 6141.0 | 6088.2 | |
Non-medication treatment costs | 26,556.5 | 14,234.1 | 10,762.6 | 9275.5 | |
Medication costs | 4775.9 | 3509.1 | 2756.9 | 2660.6 | |
Bed fees | 7274.5 | 3446.4 | 3138.9 | 2511.5 | |
Inpatient costs | 44,144.6 | 22,385.2 | 22,799.4 | 17,640.4 | < 0.001 |
Outpatient costs | – | – | 1729.7 | 1546.2 | |
Total costs (inpatient + outpatient) | 44,144.6 | 22,385.2 | 24,529.1 | 17,461.4 | < 0.001 |
Inpatient costs of schizophrenia and composition
Overall | UEBMI | URBMI | P-value | ||||
---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | ||
No. patients | n = 2971 | n = 1760 | n = 1211 | ||||
Baseline (2010.11.01–2011.10.31) | |||||||
Gender | < 0.001 | ||||||
Female | 38,472.3 | 23,410.4 | 38,225.7 | 24,643.4 | 38,890.5 | 21,176.9 | |
Male | 43,930.2 | 22,323.1 | 45,357.4 | 23,775.3 | 42,049.3 | 20,111.6 | |
Age group | < 0.001 | ||||||
18 ≤ age < 30 | 25,980.9 | 19,092.7 | 23,158.9 | 20,005.9 | 27,520.1 | 18,478.7 | |
30 ≤ age < 40 | 31,455.8 | 22,309.1 | 28,033.2 | 24,000.3 | 34,181.0 | 20,517.0 | |
40 ≤ age < 50 | 38,191.0 | 22,310.9 | 36,502.7 | 24,097.8 | 40,059.8 | 20,013.3 | |
50 ≤ age < 60 | 46,378.2 | 22,167.3 | 46,652.1 | 23,057.3 | 45,724.8 | 19,910.5 | |
≥ 60 | 50,470.3 | 20,403.9 | 50,308.8 | 21,999.6 | 50,812.8 | 16,559.9 | |
Hospital levels | < 0.001 | ||||||
Primary | 18,457.3 | 15,537.7 | 15,274.6 | 13,706.2 | 23,077.3 | 17,052.0 | |
Secondary | 31,244.4 | 17,065.9 | 31,131.6 | 17,767.6 | 31,394.8 | 16,104.8 | |
Tertiary | 47,463.3 | 23,208.1 | 48,245.2 | 24,789.2 | 46,280.6 | 20,545.9 | |
Length of stay (days) | < 0.001 | ||||||
Days ≤ 100 | 10,904.7 | 7104.7 | 11,444.1 | 7441.7 | 9885.3 | 6308.5 | |
100 < days ≤ 300 | 33,705.9 | 14,388.3 | 35,683.3 | 15,101.7 | 30,357.1 | 12,429.8 | |
> 300 days | 57,246.1 | 12,447.2 | 60,045.6 | 13,379.9 | 53,745.0 | 10,144.6 | |
Composition of inpatient costs | < 0.001 | ||||||
Laboratory and diagnostic costs | 5604.5 | 7064.7 | 7447.3 | 7778.2 | 2926.2 | 4736.8 | |
Non-medication treatment costs | 24,807.5 | 14,636.9 | 23,655.7 | 14,566.6 | 26,481.5 | 14,583.1 | |
Medication costs | 4552.4 | 3483.3 | 4655.6 | 3665.6 | 4402.4 | 3195.3 | |
Bed fees | 6816.5 | 3597.7 | 6616.5 | 3711.5 | 7107.2 | 3406.2 |
Predictors of inpatient costs
Overall | UEBMI | URBMI | |||||||
---|---|---|---|---|---|---|---|---|---|
n = 2971 | n = 1760 | n = 1211 | |||||||
Coef. | Std. err. | Marginal effect | Coef. | Std. err. | Marginal effect | Coef. | Std. err. | Marginal effect | |
Follow-up years | |||||||||
Baseline (reference group) | |||||||||
First year | 0.097*** | 0.007 | 4964.3 | 0.081*** | 0.010 | 4277.5 | 0.120*** | 0.010 | 5885.0 |
Second year | 0.087*** | 0.007 | 4443.3 | 0.075*** | 0.010 | 3973.3 | 0.102*** | 0.010 | 5027.3 |
Third year | 0.124*** | 0.008 | 6356.6 | 0.126*** | 0.011 | 6618.8 | 0.125*** | 0.011 | 6135.1 |
Age | |||||||||
18 ≤ age < 30 (reference group) | |||||||||
30 ≤ age < 40 | 0.162*** | 0.030 | 8280.9 | 0.223*** | 0.057 | 11,751.0 | 0.115*** | 0.035 | 5670.0 |
40 ≤ age < 50 | 0.042** | 0.018 | 2148.3 | 0.074** | 0.034 | 3886.1 | 0.002 | 0.018 | 116.0 |
50 ≤ age < 60 | − 0.001 | 0.010 | − 56.9 | − 0.003 | 0.015 | − 172.2 | − 0.016 | 0.012 | − 795.9 |
≥ 60 | 0.018** | 0.008 | 900.3 | 0.028*** | 0.010 | 1470.9 | − 0.011 | 0.012 | − 536.1 |
Gender | |||||||||
Female (reference group) | |||||||||
Male | − 0.016 | 0.008 | − 815.8 | − 0.004 | 0.012 | − 203.7 | − 0.032*** | 0.011 | − 1565.8 |
Insurance type | |||||||||
URBMI (reference group) | |||||||||
UEBMI | 0.103*** | 0.008 | 5270.0 | – | – | – | – | – | – |
Hospital levels | |||||||||
Primary (reference group) | |||||||||
Secondary | 0.091 | 0.047 | 4655.8 | 0.179** | 0.076 | 9423.8 | 0.0003 | 0.047 | -14.1 |
Tertiary | 0.447*** | 0.047 | 22,894.6 | 0.576*** | 0.075 | 30,330.8 | 0.299*** | 0.047 | 14,701.1 |
Length of stay (days) | |||||||||
Days ≤ 100 (reference group) | |||||||||
100 < days ≤ 300 | 1.161*** | 0.019 | 59,471.0 | 1.155*** | 0.025 | 60,862.5 | 1.165*** | 0.029 | 57,349.4 |
> 300 days | 1.707*** | 0.017 | 87,481.9 | 1.705*** | 0.022 | 89,848.1 | 1.714*** | 0.025 | 84,387.9 |
Wald chi2 | 17,506.97 | 9853.84 | 8309.63 | ||||||
P-value | < 0.0001 | < 0.0001 | < 0.0001 |