Characterizing Cross-Provincial High-Cost Patients in Rural China: Cross-Sectional Study

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• High-cost (HC) patients account for over half of healthcare spending.
• Rural Chinese residents increasingly access cross-provincial medical care and reimbursements.
• Understanding HC patients within this mobile rural population is essential.

Purpose of the Study:

• To analyze the characteristics of high-cost (HC) patients utilizing cross-provincial medical insurance in rural China.
• To identify risk factors associated with being a high-cost patient among this demographic.

Main Methods:

• Utilized data from a cross-provincial medical reimbursement system (2017-2019).
• Defined HC patients as those in the top 10% of annual medical expenditures.
• Employed Andersen's Behavioral Model and multivariable logistic regression analysis.

Main Results:

• Included 2987 patients; HC patients constituted 34.5% of total expenses.
• Average annual hospitalization cost per HC patient was $22,460.
• Male sex, multiple comorbidities, cancer diagnosis, and specialized hospital care were significant risk factors for HC status.

Conclusions:

• Cross-provincial HC patients in rural China have higher average hospitalization costs.
• Identified risk factors can inform equitable health financing policies and resource allocation.
• Targeted interventions are suggested for managing HC patients in this population.