Medical expenditure clustering and determinants of the annual medical expenditures of residents: a population-based retrospective study from rural China

OBJECTIVE: To identify the characteristics of high-cost (HC) patients and the determinants of the annual medical expenditures of Chinese rural residents. METHODS: Medical expenditure clustering was performed by Lorentz curve and Gini index. T and X(2) tests were performed to identify the characteristics of the respondents, and a multilevel regression model examined the determinants of their annual medical expenditures. DESIGN: A cluster sampling study was performed to identify those residents who availed healthcare services and to assign them to HC (top 5%), moderate-cost (top 30%) and low-cost (others) groups based on their annual medical expenditures. SETTING: The annual healthcare utilisation was calculated by using data from the population-based database of the 2014 New Rural Cooperative Medical System. PARTICIPANTS: A total of 478 051 residents who availed healthcare services were recruited for the retrospective study in 2014. The annual medical expenditures of these residents were used as the research object. RESULTS: The total medical expenditures of Macheng city residents for the year 2014 have a Gini index of 0.81 and around 68.01% of these expenditures can be attributed to HC patients. Female residents (51.5%) and persons aged over 60 years (34.48%) who are suffering from diseases that are difficult to diagnose have a high tendency to accumulate high medical costs. The annual medical expenditures of people living in the same village or town tend to be approximated. Age, disease category, inpatient status, healthcare utilisation and utilisation level are identified as the determinants of annual medical expenditures. CONCLUSIONS: The medical expenditures of rural residents are clustered at a remarkably high level, and HC patients are suffering from high economic burden. Therefore, policy-makers must guide these patients in seeking appropriate healthcare services and improve their management of healthcare quality to reduce the unnecessary healthcare utilisation of these patients. TRIAL REGISTRATION NUMBER: ChiCTR-OOR-14005563.