Medical Service Utilization and Direct Medical Cost of Stroke in Urban China

Document Type : Original Article


1 China Center for Health Development Studies, Peking University, Beijing, China

2 School of Management, Beijing University of Chinese Medicine, Beijing, China

3 National Institute of Chinese Medicine Development and Strategy, Beijing University of Chinese Medicine, Beijing, China

4 School of Economics and School of Management, Tianjin Normal University, Tianjin, China

5 Australian National Institute of Management and Commerce, Sydney, NSW, Australia

6 Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China

7 Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia

8 School of Public Health, Peking University, Beijing, China

9 Institute of Population Research, Peking University, Beijing, China

10 China Health Insurance Research Association, Beijing, China


Understanding the treatment costs of stroke can guide health policies and interventions. However, few studies have analyzed the treatment costs of stroke in China. The aim of this study is to assess stroke-related medical service utilization, direct costs of stroke and associated stroke predictors, and, second, to understand the structure of medical resource use.
This study used a 5% random sample of claim data from China’s Urban Basic Medical Insurance between January 2013 to December 2016. The sampling design assigned a sample weight to each beneficiary. Weighted descriptive analyses, Poisson regression and generalized linear model were used to analyze the medical service utilization, costs and their associations with patient characteristics.
In urban China, the annual prevalence of stroke was 730.43 (95% CI = 730.10-730.76) cases per 100 000 people, and nearly 2% of total health expenditures of urban residents was spent on stroke-related medical costs. Weighted average annual total medical cost of stroke was RMB10 637 [95% CI = 10 435-10 840] (US$1682, 95% CI = 1650-1714), with annual out-of-pocket (OOP) cost of RMB3093 [95% CI = 3026-3161] (US$489, 95% CI = 478-500). The average yearly number of stroke-related outpatient visit was 1.67 [SD = 3.39] and inpatient admission was 0.79 [SD = 0.83], with an average cost of RMB440 [SD = 739] (US$70, SD = 117) for outpatients and RMB12 702 [SD = 21 424] (US$2008, SD = 3387) for inpatients. Inpatient costs accounted for 94% (RMB10 034 or US$ 1586) of medical costs, and tertiary hospitals were the main provider of stroke care. Stroke-related medical care utilization and direct costs were associated with gender, age, pathological stroke types and insurance status. Medication costs contributed to 50.6% (RMB5382 or US$ 851) of the average stroke-related medical costs.
China’s health system bares a large economic burden from stroke. Specific policies are needed to strengthen the capacity of secondary hospitals, alter the structure of medical resource allocation, and target specific sections of the stroke population.



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Volume 11, Issue 3
March 2022
Pages 277-286
  • Receive Date: 24 December 2019
  • Revise Date: 30 March 2020
  • Accept Date: 23 June 2020
  • First Publish Date: 01 March 2022