Analysis of the changing trend of economic burden of patients with chronic diseases under the Integrated Medical and Health Service System

(2023) 23:731 Pei et al. BMC Public Health https://doi.org/10.1186/s12889-023-15572-4 BMC Public Health Open Access RESEARCH Analysis of the changing trend of economic burden of patients with chronic diseases under the Integrated Medical and Health Service System Xuedan Pei1†, Bing Wang2*†, Xiaohong Yang2, Wenming Feng3, Yanqiu Sun4, Hao Wang1, Li Gao2, Yinuo Gu2 and Yening Bei2 Abstract Background Integrating medical resources is one of the explorations of medical mechanism reform to meet the needs of whole-cycle health management and is an important initiative in the current round of China’s healthcare system reform. 2015 saw the construction of county medical communities to promote the balanced layout of medical resources, which opened a new exploration of the construction of an integrated healthcare service system in China. 2017 saw the promotion of the pilot construction of compact county medical communities in Zhejiang Province, China. Objective From the perspective of alleviating the financial burden on those in need of health services, the characteristics of chronic disease patients’ access to health care and the composition and changing curve of the medical cost burden are analyzed to provide a basis for the construction path of an integrated health care service system. Methods A retrospective cohort study was conducted to select 5739 permanent residents who met the inclusion and exclusion criteria in Z town, H city, Zhejiang province. This population’s health insurance utilization data from 2015 to 2018 were retrieved, and their average annual costs, cost composition, and health insurance payments were analyzed. Results The average annual growth rates of medical insurance and out-of-pocket costs before and after the implementation of the Medical Community were 12.85% and 9.72%, respectively. The increase narrowed significantly after the construction of the Medical Community, with the ringgit growth rate dropping to 2.73% in 2018. The top three medical expenses that accounted for the highest percentage were drug, consultation, and treatment fees. The frequency of visits to primary health care consulting hospitals has increased yearly. Conclusions By implementing various measures to strengthen the grassroots level, patients’ choice of primary care has increased year by year in the early stages of the construction of the Medical Community. From the perspective of cost control, strengthening the regulation of drugs and tests and restricting the use of high-value consumables can further reduce medical costs and ease their financial burden. † Xuedan Pei and Bing Wang are the first authors. *Correspondence: Bing Wang Full list of author information is available at the end of the article © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Pei et al. BMC Public Health (2023) 23:731 Page 2 of 7 Keywords Medical and health service system, Chronic diseases, Economic burden, Change trend The basic medical insurance system is a universal medical insurance system in China, with basic medical insurance as the mainstay, medical assistance as the backbone, and major medical insurance as an extension, whose main purpose is to alleviate the financial burden of medical expenses on citizens after receiving treatment for illnesses [1]. After years of reform, China’s medical security system has formed a medical security system consisting of the basic medical insurance for urban workers, the basic medical insurance for urban and rural residents and the new rural cooperative medical insurance system, and covers the urban employed population, the urban nonemployed population and the rural population respectively, in order to achieve the goal of full medical insurance coverage. By the end of 2021, the number of people covered by basic medical insurance reached 136,424,000 [2]. In Zhejiang province, where the economy is more developed, two types of medical insurance systems have been implemented throughout the province, namely basic medical insurance for urban workers and basic medical insurance for urban and rural residents [2, 3]. The increase in the elderly population and the emergence of chronic diseases as a significant human health problem require a shift in health services from a "curecentered" approach to a "health-centered" system based on building primary health care and health intelligence based on population density. The current hospital hierarchy in China is tertiary hospitals—secondary hospitals—primary hospitals (township health centers and community health service centers), of which township health centers/community health service centers, as an essential part of China’s primary healthcare service system, are mainly responsible for meeting the immediate healthcare needs of residents and play a crucial role in promoting the construction of a healthy China and providing accessible healthcare services to the public. However, there is a wide disparity in healthcare services in China between urban and rural areas, with quality healthcare resources mainly concentrated in large hospitals in big cities. The capacity of healthcare services within counties, especially at the grassroots level, is weak. The poor service capacity of primary healthcare institutions and the residents’ lack of recognition and trust are indisputable facts. As a result, the country is again reforming its healthcare system, focusing on integrating healthcare resources—the Integrated Medical and Health Service System. One of the construction aims is graded health management and orderly access to health care. One of the construction paths is to increase the capacity building of primary health care institutions; to increase the proportion of medical reimbursement for residents to seek medical treatment in primary health care institutions to guide residents to seek medical treatment in primary health care institutions more often. One of the indicators of the construction is the reduc (...truncated)