Study evaluates socio-economic burden imposed on Chinese healthcare system during COVID

Assessing the approximate costs of public health measures and hospitalization incurred due to the coronavirus disease 19 (COVID-19) pandemic is of utmost importance because such information can be used in the future to develop efficient strategies for controlling potential outbreaks of new infections.

In a recent study published in the journal Public Health, a research team from China has evaluated and presented the economic burden of public healthcare and hospitalization associated with COVID-19 in China.

The initial COVI19 pandemic was brought under control within a very short period of time in China. Therefore, evaluating the socio-economic burden imposed on the Chinese healthcare system during the COVID-19 pandemic may guide the governments worldwide in the management of emerging infectious disease outbreaks.

Study: Economic burden of public health care and hospitalisation associated with COVID-19 in China. Image Credit: Graeme Nicol / Shutterstock

Study: Economic burden of public health care and hospitalisation associated with COVID-19 in China. Image Credit: Graeme Nicol / Shutterstock

Background

COVID-19 pandemic continues to devastate economies while substantially impacting the global health care and medical industry worldwide. In China, as of May 20, 2020, there were 82,967 confirmed cases, 740,967 suspected close contacts, and 4,634 deaths.

To moderate the impact of the pandemic on the healthcare system, Chinese public health officials immediately implemented preventive measures in order to reduce the proportion of the population becoming infected.

In this effort, the government, healthcare system, and medical insurance system provided sufficient public health resources and hospital accommodations to restrict the spread of COVID-19 quickly.

To date, there are no studies determining the costs of both public health and hospitalization associated with COVID-19. The current study estimates the potential financial cost to control an infectious disease outbreak, in an emergency situation, without any health insurance support. Economic assessments from such studies will benefit governments worldwide in managing infectious disease outbreaks.

What did the study involve?

A cross-sectional study was performed to assess the impact of the COVID-19 pandemic on health and medical expenses in China. Data were collected from China's Centre for Chronic Disease Control (CCDC) and designated hospitals to determine the cost of public health care and hospitalization due to COVID-19 from January 20, 2020, to May 20, 2020.

Medical expenses included 'public health care costs' + 'direct hospitalization costs'.

Public healthcare costs included six aspects: nucleic acid testing (NAT), epidemiological surveys, centralized quarantine, disinfection, personal protective equipment (PPE) and health education, while the hospitalization costs included the direct cost of acute hospitalization based on the discharge settlement amount.

The team selected the Jiulongpo District located to the west of the Chongqing metropolitan region of China as the study area because it encompassed both semirural and semiurban areas and might form a good model to represent the whole of China. A total of 1.2 million people resided in Jiulongpo District, with >20 reported cases of COVID-19 during the study period. The district also included all grades of hospitals/ heath centers.

The differences in various hospitalization expenses, payment methods and duration of hospitalization in different subgroups were compared by the Wilcoxon test. A generalized linear regression model (GLM) was used to estimate the factors affecting the cost of hospitalization.

Study findings

Of the total medical expenses on COVID-19 in China, during the study period, total public healthcare expenses were found to be $6.83 billion, which were substantially higher than the direct expenses of hospitalization of $0.37 billion.

The average cost of hospitalization for severe COVID-19 ($9,278.05) was found to be four times that of hospitalization for non-severe COVID-19 ($2,017.16).

The method of reimbursement for hospitalization costs heavily influences the treatment choice for quarantined patients in hospitals. Toward this end, the Chinese government covered all the medical costs for each confirmed case that individuals would ordinarily pay.

Based on the study estimation, the government provided 30.65% (nearly $0.11 billion) of the costs associated with hospitalization for patients with confirmed cases. The average cost was found to be 2.58 times that of the average medical expenses for inpatient treatment in general. The direct medical costs associated with COVID-19 were higher compared to other common infections, possibly because patients with COVID-19 have a more extended average hospital stay (18 days vs. 8.5 days) and higher case fatality than patients with other seasonal diseases.

Of the six aspects of costs associated with public healthcare, NAT imposed an enormous economic burden on the healthcare system when both sampling and testing costs were considered.

The average cost of nucleic acid testing (NAT) and other COVID-19 diagnostic testing in high-risk populations reached $297.94 per capita, which was found to be six times that in the low-risk population, owing to the fact that the number of tests per capita was far larger in the high-risk population.

"The huge cost of NAT should be considered when deciding which population groups need to be tested and which medical institutes should perform priority NAT", highlights the team.

The costs for epidemiological surveying were approximately $389.84 for confirmed cases and $243.50 for suspected cases, which is 20-30 times higher than the survey costs for other diseases.

Other public healthcare aspects that are important for the control of COVID-19 are the use of disinfectants and PPEs. The disinfectant cost was estimated to account for more than 5% ($0.35 billion) of the public healthcare costs associated with COVID-19, and the cost of PPE accounted for 26.46% of the public healthcare costs in the current study. The cost accounted for by the PPEs is high, in part due to the shortages in masks, gowns and protective suits during the course of this study (towards the beginning of the pandemic).

Centralized quarantine of high-risk populations, which is another effective way to reduce disease transmission, accounted for 19.68% of the increased public healthcare costs associated with COVID-19, including the China government's reimbursements towards medical expenses and the costs of the accommodation and meals provided during the quarantine. In addition, the team highlights that the provision of this support from the government significantly improved compliance with centralized isolation and reduced the psychological trauma of people in quarantine.

Another public healthcare aspect of health education, in the form of making videos and publicity materials by authorities and the healthcare system to increase public awareness of COVID-19, accounted for 1.85% of the public healthcare costs associated with COVID-19.

"The estimated cost of pandemic control, especially the financial resources required from government to cover the medication and public health demand, will be of great help in achieving the goal to prevent the 'burst-out' situation of an infectious disease public health emergency" concludes the team.

Journal reference:
Namita Mitra

Written by

Namita Mitra

After earning a bachelor’s degree in Veterinary Sciences and Animal Health  (BVSc) in 2013, Namita went on to pursue a Master of Veterinary Microbiology from GADVASU, India. Her Master’s research on the molecular and histopathological diagnosis of avian oncogenic viruses in poultry brought her two national awards. In 2013, she was conferred a doctoral degree in Animal Biotechnology that concluded with her research findings on expression profiling of apoptosis-associated genes in canine mammary tumors. Right after her graduation, Namita worked as Assistant Professor of Animal Biotechnology and taught the courses of Animal Cell Culture, Animal Genetic Engineering, and Molecular Immunology.

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