Role of health insurance in averting economic hardship in families after acute stroke in China.

BACKGROUND AND PURPOSE Stroke is a major health burden in China, but there are limited data on its economic effects on households. We aimed to examine the economic impact of stroke and to assess the influence of health insurance. METHODS In a nationwide, prospective, 62-hospital registry study of acute stroke in China, we recorded information on patient demographics, clinical features, socioeconomic factors, management, and costs of medical care. Information on out-of-pocket health expenses was obtained in surviving patients at 3- and 12-month follow-up. Catastrophic healthcare payments, defined as >or=30% of total household annual income, were estimated from reported household annual income. RESULTS Among 4739 3-month survivors of stroke with outcome data, average hospital and medication costs were 16,525 Chinese Yuan Renminbi (US $2361) and out-of-pocket costs were 14,478 Chinese Yuan Renminbi (US $2068). Overall, 3384 (71%) patients had experienced catastrophic out-of-pocket expenditure. Workers without health insurance were 7 times (OR, 6.9; 95% CI, 4.6 to 10.3) more likely to experience catastrophic payments than workers with insurance. Health insurance also protected against catastrophic payments in patients who were either retired or not working (no insurance: OR, 4.7; 95% CI, 3.1 to 7.2; OR, 1.82; 95% CI, 1.3 to 2.6, respectively). CONCLUSIONS Because healthcare costs are high relative to income in China, families face considerable economic hardship after stroke. Health insurance protects families against catastrophic healthcare payments, thus highlighting the need to accelerate the ongoing process of building a comprehensive healthcare system in both urban and rural settings in China.