A study on curative care expenditure and the financing burden from different comorbidity states of chronic hepatitis B

Abstract

Abstract Background The hepatitis B incidence rate has dropped significantly in China recent years. However, the number of hepatitis B virus carriers and infected people is still relatively high due to the extensive population base. The study calculated the curative care expenditure and financing burden from different comorbidity states of chronic hepatitis B in Sichuan Province, to provide a reference for the relevant government departments to invest in the prevention and treatment of infectious diseases, and to optimize health insurance protection measures for this disease. Methods Data on the CCE of 242,749 CHB patients were collected from 1,600 healthcare institutions in Sichuan Province in 2019 using a multistage stratified random sampling method. Based on the System of Health Accounts 2011, the CCE of CHB in different comorbidity states was calculated from the dimensions of service function, financing schemes, institutional flows, and beneficiary group distribution. Results The total CCE of CHB in Sichuan Province in 2019 was USD 85.49 million. Most of the total CCE (USD 67.16 million) was spent on outpatient services, whereby the main source of financing for the outpatient expenditure was household out-of-pocket payment (75.71%). Conversely, the CCE for inpatient services (USD 18.33 million) was mainly financed by public financing schemes (46.38%). More than 70% of the CCE flowed to general hospitals, and less than 20% flowed to primary healthcare institutions, while the CCE varied significantly among different comorbidity groups. In this case, the CCE for patients with no additional comorbidities and those in the low comorbidity group was mainly spent on patients under the age of around 35 years and those in the 40–49 age group, respectively, while the CCE in the high comorbidity group was mainly used for patients aged around 50 or 55 years. Conclusions The present study shows that a high proportion of the CCE allotted to CHB is financed by household out-of-pocket payment; this situation poses a heavy medical burden on individuals. Therefore, the financing structure needs to be optimized urgently. Overall, it is imperative to continuously improve the outpatient mutual aid protection mechanism, effectively improve the curative rate for antiviral treatments aimed at CHB.