Objective  To examine major disease-related hospitalizations and their expenses among rural residents covered by New Rural Cooperative Medical Scheme (NRCMS) and to provide evidences for prevention of major diseases and adjustment of medical insurance policies in rural populations.

  Methods  The data of the study were extracted from the settlement system of NRCMS and health insurance system of Yulin city, Shaanxi province. Information on all NRCMS-reimbursed hospitalizations with a total of more than 30 000 yuan RMB out-of-pocket expense during the period from January 1, 2015 to December 31, 2016 were collected and analyzed. International Classification of Diseases-10th Revision (ICD-10) was adopted to categorize major diseases contributed to the hospitalizations.

  Results  The total number of major disease-related hospitalizations with reimbursement of NRCMS was 9 847 (5 479 and 4 368 for male and female inpatients) during the 2 year period in Yulin municipality. Of all the inpatients hospitalized, 39.2% and 33.2% were aged 45 – 59 years and 60 years and above. The proportions of hospitalized female inpatients increased with the increment of age (χ_trend² = 5.165, P = 0.023). For all the hospitalizations, the top three major diseases were tumor (3 278 person-times), circulatory system disease (1 813), and musculoskeletal system and connective tissue diseasen (847); both the longest hospital stay (median M = 30 days, interquartile range IRQ: 12 – 66 days) and highest hospitalization expense (M = 99 000 yuan RMB, IRQ: 65 000 – 183 000 yuan) were for those due to mental and behavioral disorders; the highest daily hospitalization expense (M = 8 000, IRQ: 4 000 – 18 000) was for tumor-related hospitalizations. For the hospitalizations due to circulatory system diseases and musculoskeletal system/connective tissue diseases, the average expenses (M = 97 000, IRQ: 73 000 – 133 000 and M = 85 000, IRQ: 68 000 – 105 000) of the female inpatients were significantly higher than those (M = 88 000, IRQ: 68 000 – 126 000 and M = 785 000, IRQ: 64 000 – 96 000) of the male inpatients (both P < 0.01); while, for hospitalizations due to congenital malformations/deformations/chromosomal abnormalities and injury/poisoning/external causes, the average expenses (M = 71 000, IRQ: 59 000 – 88 000 and M = 80 000, IRQ: 64 000 – 108 000) of the female inpatients were significantly lower than those (M = 85 000, IRQ: 65 000 – 105 000 and M = 93 000, IRQ: 72 000 – 132 000) of the male inpatients (both P < 0.01). For the hospitalizations due to infectious and parasitic diseases, nervous system diseases, respiratory diseases and skin/subcutaneous diseases, the average hospital expenses of the inpatients rose with the increment of age (all P < 0.05).

  Conclusion  In rural Yulin of Shaanxi province, the patients of NRCMS-reimbursed hospitalizations due to major diseases are at a relatively young age and the causes and expenses of the patients′ hospitalizations differ by age and gender. The results of the study should be concerned in the prevention and treatment of the major diseases among rural residents.