Objective  To analyze self-paid direct medical expense and economic risk among hospitalized chronic disease patients in China in 2013 and to provide evidences for developing medical insurance related policies by health departments.

  Methods  We collected the data related to hospital discharges of the inpatients with cancer, diabetes, cardiovascular and cerebrovascular diseases in China in 2013 from the China Population Statistics Yearbook – 2014 and the China Health and Family Planning Statistics Yearbook – 2014. The data on medical expenses among 6 978 inpatients with the four categories of chronic diseases were extracted from the Fifth National Health Service Survey conducted in 2013. The self-paid direct hospitalization expense of the inpatients were calculated and the economic risk due to the hospitalizations of the inpatients with various chronic diseases were assessed with relative risk (RR) and adjusted RR.

  Results  During 2013 in China, the total number of hospital discharges of the inpatients with cancer, diabetes, cardiovascular and cerebrovascular diseases, and chronic respiratory diseases was 55.05 millions; of which, 39.59 millions and 15.54 millions were urban and rural inpatients, respectively. The estimated self-paid direct hospitalization expenses for all the discharged inpatients with the four kinds of chronic diseases were 111.298 billions Yuan (RMB) and the expenses were 96.899 and 22.399 billions Yuan for the discharged inpatients from urban and rural regions; the estimated self-paid direct non-medical expenses of the hospitalizations for all the discharged inpatients were 19.699 billions Yuan and the expenses were 14.344 and 5.355 billions Yuan for the discharged inpatients from urban and rural regions. The estimated self-paid total direct economic burden of the hospitalizations for all the discharged inpatients with the four kinds of chronic diseases were 138.997 billions Yuan and the economic burdens were 54.191 and 54.034 billions Yuan for the discharged inpatients with cardiovascular/cerebrovascular diseases and cancers. In comparison to all the discharged inpatients, the inpatients with the four chronic diseases had a higher adjusted relative risk (RR) of the hospitalization-related direct medical and non-medical economic burden; the RR of the hospitalization-related direct medical economic burden for subgroups of the chronic disease inpatients were as following: 2.95 (with hospitalization days of ≥ 22), 2.36 (with the lowest economic condition), 1.80 (having a surgery), 1.43 (with medical insurance for urban residents), 1.31(with hospitalization days of 15 – 21), 1.25 (with medical insurance other than for urban or rural residents), 1.22 (with lower economic condition), 1.20 (hospitalized in tertiary hospitals), 1.13 (hospitalized in secondary hospitals), 1.13 (with integrated medical insurance), 1.06 (having caregivers during hospitalization), 1.05 (with New Rural Cooperative Medical Insurance), and 1.02 (with moderate economic condition); while, the RR of the hospitalization-related direct non-medical economic burden for subgroups of the chronic disease inpatients were as following: 4.07 (with hospitalization days of ≥ 22), 3.16 (with the lowest economic condition), 2.14 (having a surgery), 2.16 (hospitalized in secondary hospitals), 1.64 (with New Rural Cooperative Medical Insurance), 1.49 (having caregivers during hospitalization), 1.41 (with lower economic condition), 1.41 (with integrated medical insurance), 1.41(with hospitalization days of 15 – 21), 1.28 (with moderate economic condition), 1.21 (with medical insurance other than for urban or rural residents), and 1.17 (hospitalized in tertiary hospitals).

  Conclusion  The hospitalized chronic disease patients had a heavier economic burden due to self-paid direct medical expense in 2013 and the patients with longer hospitalization duration, low economic condition or having surgeries had higher risk of economic burden of direct medical and non medical expense.