Hospitalization costs and out-of-pocket expenses for stroke patients in mainland China

This study aimed to assess hospitalization expenditures and out-of-pocket burden (OOPB, defined as out-of-pocket expenses [OOPE] divided by disposable annual income multiplied by household size and expressed as a percentage) in patients with stroke in mainland China from 2019 to 2020.

This research encompassed patients from hospitals jointly affiliated with the Chinese Hospital Quality Monitoring System and the Big Data Observatory Platform for Stroke of China. We focused on individuals hospitalized between 2019 and 2020, who were primarily diagnosed with a stroke, as classified under the ICD-10 codes: ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). We estimated the out-of-pocket rate (OOPR, defined as OOPE divided by hospitalization expenditures expressed as a percentage), high OOPB, and catastrophic healthcare payments (defined as OOPB exceeding 30%) at the national and provincial levels. The correlation between OOPR and in-hospital mortality in different provinces was also examined.

The database included 7,226,376 stroke patients from 1,599 hospitals, of whom 58.6% were male. The OOPR and OOPB in stroke patients were 32.6% (95% CI, 31.9%-33.3%) and 6.3% (95% CI, 6.1%-6.4%), respectively. For IS and ICH, more than two-thirds (22/32) of China's provinces had an OOPR of over 28.0%, while three-quarters of provinces (24/32) for SAH had an OOPR of over 28.0%. For IS and ICH, none of the provinces had catastrophic healthcare payments, whereas for SAH, over half of the provinces (18/32) did. We analyzed the relationship between OOPR and stroke in-hospital mortality at the provincial level, but the data did not confirm a correlation between the two factors (IS: r=-0.172, P=0.34; ICH: r=0.078, P=0.67; SAH: r=0.041, P=0.82).

The acute hospitalization costs and OOPB on stroke patients is significant, with nearly a third of their medical costs paid out-of-pocket. This underscores the pressing necessity to advance the development of a more inclusive healthcare system, particularly in economically challenged regions.