Research on the relationship between the species of chronic diseases and medical services utilization and expenses: a cross sectional survey in rural areas of Jiangsu Province

摘要

Background : As high-need, high-cost (HNHC) patients, people with chronic illness, especially who suffered from multiple chronic illnesses have significant features. Previous studies indicated that the utilization of medical services and medical expenses of patients with chronic diseases was higher than the healthy population, but there was little research on the relationship between the species of chronic diseases and the utilization of medical services as well as medical expenses. Methods : With random cluster sampling method, 1600 patients with chronic illness were inquired by an investigation with the questionnaire for rural residents, which provides information of chronic conditions, medical records, etc. in Jiangsu Province. Use SPSS 19.0 to process and analyze data. Compare the differences among patients with one, two, and three or more chronic illnesses in characteristics and utilization patterns by descriptive statistics, Chi-square test and correlation analysis. Results : 1123, 398, and 79 patients suffer from one, two, and three or more chronic illnesses (70.19%, 24.88%, 4.94%). Annual health care expenses of one species of chronic disease group accounted for the proportion of total medical expenses of chronic diseases patients is 64.76%, for two and three or more species of chronic diseases groups are 29.33% and 5.90%. Outpatient, inpatient and pharmaceutical purchase times increased related to the species of chronic diseases. Expenses in purchasing pharmaceutical of three or more species of chronic diseases group is significantly higher than that of the other two groups. Otherwise, total costs and inpatient costs in the past year per capita have no statistically significant among three groups (P0.05). Conclusion : Patients with two or more chronic diseases have a higher proportion of medical expenses, the species of chronic diseases and the times of medical services utilization showed the significantly positive correlation. We should focus on strengthening the health management and medical insurance support for multiple chronic diseases patients, to reduce the economic burden of the disease and the risk of high need and high cost.