Study On The Economic Burden And Affecting Factors Of Rural Stroke Patients In Shandong Province

Stroke is one of the most common chronic diseases in China. It not only has a high incidence rate, but also has higher disability and mortality rates. Compared with the whole world, the cerebrovascular disease in China has two big features: First, the incidence of stroke in Europe and the United States is falling, but in China it is rising; Second, the recurrence rate of cerebrovascular disease in our country is very high. China has two million new stroke patients each year. In addition, the high disability and recurrence rate of stroke lead to a heavy financial burden for the family and the community. Therefore, a comprehensive understanding of the economic burden caused by stroke, especially the financial burden of patients in rural areas has practical significance to China which has a large rural population. The research studied on the economic burden of rural stroke patients in Shandong Province and the main factors affecting the financial burden comprehensively, it provided an objective basis to find ways to reduce the economic burden of stroke and improve the social and economic benefits of health investment.To assess the economic burden of stroke for the rural population, the study randomly selected Laiyang, Xiajin, Gaotang three counties according to the various economic situation and geographical position in Shandong Province, and then randomly selected 167 stroke patients from these counties. Using the questionnaire "Investigation of economic burden of rural stroke patients" which designed by research group according to the purpose of the study, the investigators conducted a household questionnaire survey. We collected and analyzed the sociology and population information of stroke patients and information about the disease, the use of medical services, the preventive care, the direct economic burden, the indirect economic burden, the potential economic burden and the main factors affecting the economic burden. The direct economic burden included direct medical costs in last year (including costs of outpatient, hospital costs and costs of self-medication) and direct non-medical costs (including transportation fees, accommodation fees and restaurant fees which come into being in the process of using medical services). The indirect economic burden included working time loss, loss of household labor and the burden to relatives (who accompanied in the required time) in last year.After the analysis of the data collected, we found that the costs of outpatient, hospital costs, costs of self-medication, transportation fees, accommodation fees and restaurant fees which involved in the direct economic burden all showed a skewed distribution. So we used the median and rank sum test to describe the statistics and do the non - parametric statistical tests for a more reasonable reflection of the direct economic burden of stroke patients. In the process of analyzing the main factors affecting the economic burden of stroke, we conducted single factor analysis and multivariate analysis. In the multivariate analysis, we used the two part model to analyze the probability of outpatient and hospitalization, the costs of outpatient and hospitalization systematically, then found out the main factors affecting the use of medical services and the economic burden, and provided an objective basis to find ways to reduce the economic burden of stroke. Based on the statistical analysis, this study is followed by these conclusions:The median of the direct economic burden of rural stroke patients in Shandong province during the recent one year was 1,106 yuan. In direct medical costs, the median of patient self-medication costs was higher than the median of outpatient costs which was higher than the median of hospital costs. Viewing the direct medical cost each time, the hospital cost per time was much higher than the outpatient cost per time which was much higher than the medication cost per time. The direct non-medical cost of rural stroke patients in Shandong Province was relatively low, and it took a small proportion in the total direct economic burden. The median of transportation fees was the highest in direct non-medical costs.The per capita indirect economic burden of rural stroke patients in Shandong province during the recent one year was 5576.97 yuan. The delays loss was the biggest, the loss of relatives who accompanied in the required time was second, and the loss of household labor was the smallest. The average indirect economic burden of each female patient was bigger than each male patient, to 6905.91 yuan and 4728.65 yuan respectively. The per capita indirect economic burden of 30-49 age group was the biggest, while the per capita indirect economic burden of 50-59 age group was the smallest.In addition to the direct and indirect economic burden, the potential economic burden of rural stroke patients in Shandong province which was generated by the unmet medical services and related care is not overlooked. In this investigation, patients with unsatisfied hospital services accounted for 34.1% of the whole patients, patients with unsatisfied patient services accounted for 7.2% of the whole patients, patients with unsatisfied checking services accounted for 33.5% of the whole patients, patients with unsatisfied medication accounted for 43.1% of the whole patients, patients without unsatisfied medical services accounted for only 15.0% of the whole patients. Patients needing more accompanying care accounted for 35.5% of the whole patients. These patients need to increase 165.39 days accompanied by per capita annually, and the potential financial burden brought by that was 1424.84 yuan per capita annually. According to the single-factor analysis of the economic burden of stroke, we find that the direct economic burden of rural stroke patients in Shandong Province had relation with following factors: education, medical spending, living conditions, incidence time, severity of disease, complications, utilization of medical services. According to the multiple linear regression analysis of the economic burden of stroke, we find that the most important factor affecting the cost of outpatient was disability grade, followed by incidence time and education, medical expenses and profession were less important; the most important factor affecting the hospital cost was hospital days, followed by living conditions, daily living ability was less important.In view of the economic burden of rural stroke patients in Shandong Province and the main factors concluded from this study, We propose the following policies and measures to effectively control the economic burden of stroke and improve living standard and life quality of rural patients: Actively develop community health service, improve prevention of stroke; Emphasize standardized treatment of stroke, reduce hospital days; Promote rational drug use, lower drug price; Pay attention to the prevention and treatment of chronic diseases, increase government's input; Further develop the rural health system and medical insurance system.