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(Stroke. 2009;40:2149.)
© 2009 American Heart Association, Inc.

Original Contributions

Role of Health Insurance in Averting Economic Hardship in Families After Acute Stroke in China

Emma Heeley, PhD; Craig S. Anderson, MD; Yining Huang, MD; Stephen Jan, PhD; Yan Li, MD; Ming Liu, MD; Jian Sun, MD; En Xu, MD; Yangfeng Wu, PhD; Qidong Yang, MD; Jingfen Zhang, MD; Shihong Zhang, MD; Jiguang Wang, MD for the ChinaQUEST Investigators

From The George Institute for International Health (E.H., C.S.A., S.J.), Royal Prince Alfred Hospital and the University of Sydney, Sydney, Australia; Peking University First Hospital (Y.H.), Beijing, China; Shanghai Institute of Hypertension (Y.L., J.W.), Rui Jin Hospital, Shanghai Jiagtong University, Shanghai, China; West China Hospital (M.L., S.Z.), Sichuan University, Chengdu, China; The George Institute China (J.S., Y.W.), Peking University Health Science Center, Peking, China; The Second Affiliated Hospital of Guangzhou Medical College (E.X.), Guangzhou, China; Xiangya Hospital of Centre–South University (Q.Y.), Changsha, China; and Baotou Cental Hospital (J.Z.), Baotou, Inner Mongolia, China.

Correspondence to Emma Heeley, PhD, The George Institute for International Health, PO Box M201, Missenden Road, Camperdown NSW 2050, Australia. E-mail eheeley{at}george.org.au

Background and Purpose— Stroke is a major health burden in China, but there are limited data on its economic effects on households. We aimed to examine the economic impact of stroke and to assess the influence of health insurance.

Methods— In a nationwide, prospective, 62-hospital registry study of acute stroke in China, we recorded information on patient demographics, clinical features, socioeconomic factors, management, and costs of medical care. Information on out-of-pocket health expenses was obtained in surviving patients at 3- and 12-month follow-up. Catastrophic healthcare payments, defined as 30% of total household annual income, were estimated from reported household annual income.

Results— Among 4739 3-month survivors of stroke with outcome data, average hospital and medication costs were 16 525 Chinese Yuan Renminbi (US $2361) and out-of-pocket costs were 14 478 Chinese Yuan Renminbi (US $2068). Overall, 3384 (71%) patients had experienced catastrophic out-of-pocket expenditure. Workers without health insurance were 7 times (OR, 6.9; 95% CI, 4.6 to 10.3) more likely to experience catastrophic payments than workers with insurance. Health insurance also protected against catastrophic payments in patients who were either retired or not working (no insurance: OR, 4.7; 95% CI, 3.1 to 7.2; OR, 1.82; 95% CI, 1.3 to 2.6, respectively).

Conclusions— Because healthcare costs are high relative to income in China, families face considerable economic hardship after stroke. Health insurance protects families against catastrophic healthcare payments, thus highlighting the need to accelerate the ongoing process of building a comprehensive healthcare system in both urban and rural settings in China.

Key Words: epidemiology • health policy • stroke

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