Medical expenditure and its influencing factors of patients with hypertension in Shanxi Province, China: a study based on ‘System of Health Accounts 2011’ and multiple-layer perceptron neural network

OBJECTIVES: To study the medical expenditure and influencing factors of patients with hypertension in Shanxi Province, China. DESIGN: A cross-sectional study. SETTING: 1088 medical institutions, including general hospitals, traditional Chinese medicine hospitals, special hospitals, basic medical institutions and public health institutions. PARTICIPANTS: 180 441 hypertensive outpatients and 14 763 inpatients from 1 January to 31 December 2017. PRIMARY AND SECONDARY OUTCOME MEASURES: Curative care expenditure for hypertension (CCE(ht)) was measured based on System of Health Accounts 2011. Influenced factors were analysed by univariate analysis and multiple layer perceptron neural network. RESULTS: In 2017, CCE(ht) was US$307.71 million, accounting for 3.63% of total CCE and 0.14% of gross domestic product (GDP) in Shanxi Province of China. CCE of hypertensive outpatients (CCE(ht-out)) and inpatients (CCE(ht-in)) accounted for 44.49% and 55.51% of CCE(ht). Drug fee accounted for 81.55% of CCE(ht-out) and 22.50% of CCE(ht-in), respectively. The top three influencing factors were drug fee, surgical fee and hospitalisation days for inpatients, and drug fee, examination fee and test fee for outpatients. CONCLUSIONS: The medical expenditure of hypertension is still heavy for individuals and society. The diagnosis and treatment capacities of primary healthcare system has been enhanced. New rural cooperation medical insurance and urban employee basic medical insurance have a trend of overusing, and the burden of family healthcare expenditure is still heavy. To ease the economic burden of patients with hypertension and improve the efficiency of social resources utilisation, policymakers should pay more attention to key groups, further increase support for primary healthcare system, standardise the treatment and reimbursement of hypertension and incline the reimbursement policy to outpatient service.