Objective To analyze the demand and utilization of medical service, medical expenses and related family economic risks among chronic disease patients participating in different medical insurance in China for conducting evidence-based reform of medical insurance system.
Methods The dataset on 229 999 residents aged 15 and over were from the Fifth National Health Service Survey carried out in 2013 in all provincial level regions in China. From the dataset, we extracted and analyzed the information on health service demand and utilization, medical expenses and family economic risk due to the expenses for 51 890 residents with chronic diseases.
Results Of all the chronic disease patients included the study, 15 898 (30.6%) were covered by Urban Employees′ Basic Medical Insurance (UEBMI), 4 301 (8.3%) by Urban Residents′ Basic Medical Insurance (URBMI), 21 087 (40.6%) by New Rural Cooperative Medical System (NRCMS), 494 (1.0%) by Universal Social Basic Medical Insurance (USBMI), 6670 (12.9%) by Urban-Rural Resident Basic Medical Insurance (URRBMI), 2 298 (4.4%) by mixed medical insurance, and 1 142 (2.2%) by other insurance systems, respectively. Among the chronic disease patients participating in different medical insurance systems, those covered by UEBMI had the highest additive disease-specific two-week prevalence rate (114.8%) and two-week physician-prescribed treatment rate (111.1%), hospitalization rate (25.3%), and ratio of hospitalization in tertiary hospitals (49.3%); the patients with URBMI had the highest ratio of refusing to have required hospitalizations due to economic reasons (62.8%) and the proportion of average out of pocket medical expenses per hospitalization versus family disposable income (14.0%); the patients with NRCMS had the highest rate of required hospitalization (30.7%) and the ratio of having their initial medication seeking at grassroots medical institutions (82.5%); the patients with USBMI had the highest average total hospitalization medical expense (8 850.0 yuan RMB); and the patients with other types of medical insurance had the highest rate of not seeking medication while being ill due to economic reasons (6.2%), average out of pocket medical expenses for chronic disease treatment during past two weeks (98.0 yuan RMB) and the proportion of out of pocket medical expense per outpatient visit versus family disposable income (0.6%).
Conclusion There are disparities in demand and utilization of medical service, medical expense and medication related family economic risk among chronic disease patients with different types of medical insurance. The results suggest that for the improvement of medical insurance with a higher level of assurance, more attentions should be paid to the control of chronic disease patients′ medication expense to promote the patients′ reasonable medication; while, for the medical insurance with a lower level of assurance, more attentions should be paid to the upgrade of insurance capability.
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