title: Inpatient care burden due to cancers in Anhui, China: a cross-sectional household survey.
abstract: BACKGROUND
  The financial burden of cancers has profound effects and there is a clear need to explore the issue from different perspectives and for different population groups. This study aimed at investigating inpatient cancer care (ICC) burden in Anhui, a typical inland province of China.
  
  
  METHODS
  The study collected data through a household survey conducted during April to November, 2014 using cluster-randomized sampling and a structured questionnaire administered face-to-face by trained interviewers.
  
  
  RESULTS
  The survey covered 60,678 urban and rural residents and 318 person-times of ICC during the past year. Age-adjusted annual person-times and days of ICC per thousand population added up to 4.24 and 76.78 respectively and urban residents showed significantly greater admission rates and length of stay than that of rural ones. Total ICC expenditures accounted for 13.30 % of all that of inpatient care for the whole population. Per-case direct and indirect costs of all types of cancers were estimated as 10365.1 and 929.9 RMB. Per-case total cost on ICC at township hospitals was 2142.3 RMB and at province level hospitals, 17133.0 RMB. Significant variations in per-case ICC expenditures also existed between patients with different household income and type of medical insurance systems, but patients suffering from different types of cancers. Out-of-pocket payment due to ICC turned out to be catastrophic for 20.6 % of all cancer patients and 65.2 % for other medical insurance, 45.6 % for enrollees of urban and rural medical insurance, 43.2 % for the 65 to 74 years old. Multi regression revealed statistically significant association between ICC costs and education, reimbursement ratio, household income and level of hospital.
  
  
  CONCLUSIONS
  Cancers characterize low incidence, moderate service use and high expenses. There exist substantial differences between subgroups and part of these variations cannot be explained by pathological factors. ICC expenses are catastrophic in nature to a large part of patients. There is a clear need for more effectively regulating cancer-related medical practices and service seeking behaviors.
authors.affiliation: School of Health Services Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Zhao
authors.affiliation: School of Health Services Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.|Department of Epidemiology and Statistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Cheng
authors.affiliation: School of Health Services Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chai
authors.affiliation: Library Department of Literature Retrieval and Analysis, Anhui Medical University, 81 Meishan Road, Hefei, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.affiliation: School of Health Services Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
authors.forename: Han
authors.initials: H
authors.lastname: Liang
authors.affiliation: School of Health Services Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
authors.forename: Xingrong
authors.initials: X
authors.lastname: Shen
authors.affiliation: School of Health Services Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Sha
authors.affiliation: School of Health Services Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China. dbwang@vip.sina.com.
authors.forename: Debin
authors.initials: D
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Cancer; Costs; Financial burden; Household survey; Inpatient care