| Cardiovascular and cerebrovascular disease was general term for cardiovascular and cerebrovascular disease.At present,cardiovascular and cerebrovascular disease had become the leading cause of death in Jilin,which became a prominent public health problem in prevention and control.The prevention of cardiovascular and cerebrovascular disease could not be separated from funding input and effective health financing policy.Health expenditure accounting was internationally recognized as an analysis tool for health financing policy analysis.Accounting the health expenditure of cardiovascular and cerebrovascular diseases and evaluating the health resource consumption on cardiovascular and cerebrovascular diseases in Jilin could reflect the health expenditure of cardiovascular and cerebrovascular diseases by financing schemes,health providers,beneficiary groups and economic burden of individuals and society,which had important significance for adjusting and implementing the related policies for cardiovascular and cerebrovascular disease in Jilin.Objectives:1.Accounting the health expenditure of cardiovascular and cerebrovascular disease by quantity and financing schemes.Analyzing the financing schemes and main problems of financing in Jilin.2.Accounting and analyzing health expenditure of cardiovascular and cerebrovascular disease by health providers and functions in Jilin.3.Accounting and analyzing curative care expenditure by different types of cardiovascular and cerebrovascular diseases in Jilin.4.Accounting and analyzing curative care expenditure by beneficiary groups in Jilin.5.Accounting the curative care expenditure of cardiovascular and cerebrovascular disease of the elderly in Jilin,and analyzing curative care expenditure by financing schemes,health providers and functions,so as to provide evidences for the decision-making on rationally controlling the burden of cardiovascular and cerebrovascular disease among the elderly.Methods:1.Health Expenditure Accounting:Based on the latest international version A System of Health Accounts 2011 Edition(SHA2011),accounting the health expenditure of cardiovascular and cerebrovascular disease by financing schemes,health providers,functions and diseases and beneficiary groups.2.Data Collecting:The demanded data included normal statistic data and the field work based on health providers.The total health expenditure of the normal statistic data,came from the Research Report of Chinese Total Health Expenditure by National Health and Family Planning Commission.The statistic data of Jilin,included Health Statistics Yearbook of Jilin Province,Health Financial Yearbook of Jilin Province and the database of "Government Health Input Monitoring of Jilin Province".The second type of data came from the field work based on health providers,came from the survey of health expenditure accounting in Jilin Province,included the individual data of the patients’ age,gender,diagnosis,curative care expenditure and the prevention input information questionnaires acquired from the information system and medical record system of hospitals,public health institutions and primary medical institutions.Results:1.The current health expenditure of cardiovascular and cerebrovascular disease in Jilin ProvinceIn 2014,the current health expenditure of cardiovascular and cerebrovascular disease was 7.11 billion yuan in Jilin province,accounted for 11.26%of total health expenditure in Jilin province,accounted for 22.20%of chronic disease health expenditure,and accounted 0.52%of GDP.The curative care expenditure of cardiovascular and cerebrovascular disease accounted for 69.65%of health expenditure,while the proportion of the health expenditure from the retailers and other providers of medical goods was 14.43%.In addition,the proportion of preventive care expenditure and health expenditure from health care system administration and financing were 8.98%and 6.83%,respectively.2.Financing scheme of health expenditure on cardiovascular and cerebrovascular disease in Jilin ProvinceIn 2014,the curative care expenditure of cardiovascular and cerebrovascular disease amounted to 4.95 billion yuan,among which public financing schemes took up 47.55%,household out-of-pocket took up 44.57%and voluntary financing schemes took up 7.88%.The public financing scheme was main part of inpatient care expenditure in curative care expenditure,which accounted for 51.98%,and household out-of-pocket accounted for 38.43%.On contrary,the household out-of-pocket amounted for 64.84%in outpatient care expenditure,while public financing schemes amounted for 32.92%.According to the distribution of health expenditure by diseases,the financing coverage of nutritional and metabolic disease,transient ischemic attack,brain atrophy and other acquired cardiovascular disease and minor stroke(stroke)were in good condition,the proportion of the public health financing scheme was above 52%.The top 5 diseases of household out-of-pocket were essential hypertension,pulmonary heart disease,cerebral infarction,congenital heart disease and heart disease resulted from blood,which amounted for 59.11%,50.30%,50.17%,45.08%and 41.13%,respectively.According to the distribution of health expenditure by age group,the financing scheme of cardiovascular and cerebrovascular disease mainly depended on public financing schemes and household out-of-pocket.The proportion of household out-of-pocket in some age group was above 50%.The household out-of-pocket proportion of age groups from 10 to 14,60 to 65 and 85 to 95 were between 50%and 60%.Besides,the household out-of-pocket proportions of age groups from 0 to 4 and 15 to 19 were above 60%.3.Distribution of health expenditure by health providersIn 2014,the health expenditure of cardiovascular and cerebrovascular disease mainly occured in hospital,accounting for 59.29%.Retailers and other providers of medical goods and primary health care institutions accounted for 14.43%and 14.17%,respectively.Providers of health care system administration and financing,providers of ambulatory health care and providers of public health(providers of preventive care)accounted for 6.83%,3.84%and 1.34%,respectively.According to the distribution of financing schemes by health providers.The government scheme in primary health care institutions amounted for 37.47%,and amounting for 36.17%in hospital.Both the proportion of the government scheme in providers of ambulatory health care and providers of ancillary services were less than 1%.Compulsory contributory health care financing schemes in hospital accounted for 74.45%,while it amounted for 6.60%in primary health care institutions.Besides,the proportion of compulsory contributory health care financing schemes in retailers and other providers of medical goods was 18.94%.According to the distribution of different function of health care expenditure by health providers.The curative care expenditure mainly occurred in hospitals,which accounted for 84.75%.The preventive care expenditure mainly occurred in primary health care institutions,which accounted for 79.64%of preventive care expenditure.4.Distribution of health expenditure by different cardiovascular and cerebrovascular disease in JilinThe top 5 cardiovascular and cerebrovascular diseases in health expenditure were other types of heart disease,atherosclerosis,cerebral infarction,cerebral hemorrhage,minor stroke(stroke),accounting for 65.25%,17.57%,9.67%,2.44%and 1.85%,respectivelyAccording to health expenditure of different types of cardiovascular and cerebrovascular diseases by health providers.The curative care expenditure in hospital were other types of heart disease,atherosclerosis,cerebral infarction,cerebral hemorrhage,minor stroke(small stroke),accounting for 66.75%,20.56%,4.65%,2.82%and 2.07%.The curative care expenditure in primary health care institutions were other types of heart diseases,cerebral infarction,pulmonary heart disease,atherosclerosis,minor stroke(stroke),accounting for 60.32%,34.14%,3.17%,1.37%and 0.36%.According to health expenditure of different types of cardiovascular and cerebrovascular diseases by gender.The top 5 diseases of health expenditure in male were other types of heart diseases(1.661 billion yuan),atherosclerosis(459 million yuan),cerebral infarction(393 million yuan),essential hypertension(28 million yuan)and minor stroke(stroke)(23 million yuan).The health expenditure of 5 diseases amounted for 95.21%in male.The top 5 diseases of health expenditure in male were other types of heart diseases(1.35 billion yuan),atherosclerosis(448 million yuan),cerebral infarction(316 million yuan),hemorrhagic cerebrovascular disease(48 million yuan),congenital cardiovascular disease(20 million yuan)and pulmonary heart disease(20 million yuan).The health expenditure of 5 diseases amounted for 97.30%in female.5.Distribution of health expenditure by ageIn 2014,the curative care expenditure of cardiovascular and cerebrovascular diseases mainly occurred on age group from 80 to 84,60 to 64,70 to 74,75 to 79,65 to 69.These 5 age groups amounted for 58.78%.As for different types of cardiovascular and cerebrovascular diseases by age,the curative expenditure mainly occurred in age group from 45 to 85.According to the distribution of health expenditure of gender by age,the top 5 of health expenditure were age groups from 80 to 84,70 to 74,60 to 64,75 to 79,65 to 69.The top 5 age groups in male aged from 80 to 84,85 to 89,60 to 64,75 to 79,70 to6.Analysis on health expenditure on cardiovascular and cerebrovascular diseases among the elderly above 60In 2014,the curative care expenditure of the elderly above 60 amounted to 3.49 billion yuan,accounted for 70.46%of total health expenditure on cardiovascular and cerebrovascular diseases.As for the curative care expenditure of the elderly by age,the curative care expenditure mainly happened on age group from 80 to 84,amounted for 22.55%of the curative care expenditure among the elderly.According to the distribution by diseases,the curative care expenditure mainly occurred on other types of heart disease,atherosclerosis,cerebral infarction,hemorrhagic cerebrovascular disease and essential hypertension,accounting for 62.60%,17.81%,14.35%,1.81%and 1.10%.Among the curative care expenditure of the elderly,household out-of-pocket amounted for 48.87%,public financing scheme amounted for 47.96%.The top outpatient care expenditure was the household out-of-pocket,which amounted for 71.47%.The proportion of public financing scheme in the inpatient care expenditure was relative high,amounted for 52.63%.According to the curative care expenditure of the elderly by health providers,the proportion of hospital was 86.64%,while the primary health care institutions and providers of ambulatory health care amounted for 8.82%and 4.54%respectively.As for the outpatient care expenditure,the outpatient care expenditure in hospital amounted for 55.31%,while the primary health care institutions amounted for 21.08%.As for the inpatient care expenditure,the inpatient care expenditure in hospital amounted 94.08%,while the primary health care institutions amounted for 5.92%.Conclusions:1.The proportion of health expenditure on cardiovascular and cerebrovascular diseases was extremely high in Jilin Province,and the consumption of health resources was large,which brought heavy burdens to the social economy and the family.In the future,it should strengthen the control of cardiovascular and cerebrovascular diseases.2.The proportion of household health expenditure was relatively high in financing schemes of Jilin Province.The government should increase the investment,and heighten the levels of health care and focus on the coverage of health care based on differences financing burden of disease and age groups3.The allocation of health expenditure on cardiovascular and cerebrovascular disease was unreasonable in Jilin Province.The health expenditure mainly occurred in hospitals or high level institutions,while the proportion of primary institutions was relatively low.On the other hand,the proportion of curative care expenditure was relatively high,while the proportion of preventive services was relatively low.4.The health expenditure of cardiovascular and cerebrovascular disease mainly concentrated on several key diseases in Jilin Province.There were different distributions of health expenditure among diseases in gender groups.It was time to control these key diseases5.The health expenditure of cardiovascular and cerebrovascularr disease mainly occurred on the elderly in Jilin Province.But the proportion of young people was still large.In addition,the differences still existed in the health expenditure of cardiovascular and cerebrovascularr disease by gender and age groups.It should attach importance to the policy.6.The proportion of curative care expenditure among the elderly above 60 years old was relatively high in Jilin Province,especially for the health resources consumption of the elderly aged from 80 to 84.The economic burden of cardiovascular and cerebrovascular disease among the elderly was still heavy.The financing structure should be optimized,the distribution of curative care expenditure was not reasonable,and the efficiency of health resource allocation needed to be improved.Policy Advice:1.To attach great importance to the prevention and treatment of cardiovascular and cerebrovascular diseases,identify the responsibility of governments at all levels,increase the input of public health services for cardiovascular and cerebrovascular system.2.To further improve the medical insurance policy,improve the levels of social medical insurance financing and the efficiency of the health financing,improve the medical insurance compensation policy based on features of cardiovascular and cerebrovascular disease,improve levels of financing and the pertinence of medical assistance3.To explore the hierarchy medical service system based on the characteristics of cardiovascular and cerebrovascular diseases,strengthen the service capacity and mechanism of primary health care institutions,achieve rationalization of medical treatment and early control of the disease,thus to fundamentally reduce the expenditure.4.To control the heavy economic burden of cardiovascular and cerebrovascular diseases.It should strengthen the key prevention and control of cardiovascular and cerebrovascular diseases,and use information technology to control the occurrence and development of key cardiovascular and cerebrovascular diseases5.To concern about prevention of the whole life cycle of cardiovascular and cerebrovascular disease.To strengthen the early prevention and control of cardiovascular and cerebrovascular disease among young and middle-aged people,focus on prevention and control of the elderly population and reduce the economic burden of disease and health expenditure.6.To strengthen the control of cardiovascular disease and the risk of financing among the elderly,pay attention on the prevention and treatment of cardiovascular and cerebrovascular disease among elderly above 60 years old,and pay more attention to the medical insurance policy for the elderly above the age of 80It should accelerate the development of commercial health insurance so as to provide multiple health protection for the elderly to cure the cardiovascular and cerebrovascular diseases.Meanwhile,it needed to encourage non-governmental organizations and enterprises to invest in prevention of cardiovascular and cerebrovascular disease in Jilin Province. |
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