The impact of NCDs on the health burden is global, and its economic burden is the heaviest of all types of disease. In LMICs, it is simultaneously a rapid growth in the health and economic burden of NCDs . In Middle-income countries, such as Russia and India, where the OOP burden of NCD payments has been found to be significant; Even in the United States, NCDs are among the most prevalent and costly health conditions. NCDs receives comparatively little attention compared to infectious disease treatment . So far, only four Asian countries, that have published information on NCDs financing , and those were years ago. Which presents us with a challenge in formulating health policy. The purpose of this study is to describe the economic expenditure of NCDs in Dalian, and to analyze the similarities and differences between different types of NCDs, different medical institutions, different service function, different ICD-10 categories, and the influencing factors to inpatient expenditure.
Previous studies show a steady global increase in household expenditure on NCDs from 1999 to 2014. In 2018, The CCE of NCDs accounts for 65% of the total CCE, considering the number of included samples, the average health cost of NCDs may be higher than other diseases. Therefore, we should take more forceful measures to deal with the possible impact of NCDs, which is also the call of The United Nations and WHO [35–36].
This study shows that the CCE of NCDs is related to age, before the age of 65, the CCE increases with the increasing of the age, this is similar to previous studies, the people who are over the age of 60 are at high risk of NCDs [37–38]. At present, because of the unhealthy lifestyle, 150 million young people smoking, 84% of teenage girls and 78% of boys who lack physical exercise, 11.7% of teenagers drink alcohol, while 41 million children under the age of five are overweight or obese around the world , NCDs is becoming younger. Previous studies have shown that high blood pressure and diabetes, are on the rise among young people[39–40], this study found that CCE of NCDs higher group is 45–84 age group. Although the elderly are still the main focus of NCDs, we should not ignore the young and we should advocate a healthy lifestyle, such as not smoking, drinking less alcohol, and taking more exercise [41–42].
The CCE financing of NCDs mainly comes from public financing scheme, although the proportion of family health expenditure is lower than total disease, it still above 30%. Contrary to other studies [6–7], this may be due to higher health expectations among residents of economically developed regions . In recent years, China has adopted some active health policies, in 2013, China's basic medical insurance coverage has reached more than 95%, in 2017, began to implement Drug zero markup policy, in 2018, the national basic Public health benefits have increased from 50 to 55 CNY per person. All this has dramatically reduced household health spending. However, NCDs is easy to cause household poverty [46–47], and we should continue to increase financial support to reduce household spending, especially for hospitalized patients, the proportion of family health expenditure is higher.
In China, high-quality medical resources are mostly concentrated in the 3A (Class Three/Grade A) hospitals, although graded treatment has been carried out for some years, the results are not significant. People tend to go straight to the 3A hospital . The CCE of NCDs in Dalian city accounts for nearly 90% in the hospital, higher than that of all diseases, which shows that the hierarchical diagnosis and treatment advocated in China's medical reform is not carried out smoothly. For NCDs, primary health care, such as primary health care institutions and public health agencies, should be given more responsibility . NCDs have a long course and require frequent medical treatment [9–10]. While 80.00% of basic medical care can be provided in primary medical and health institutions, and more medical resources can be used for NCDs treatment in primary medical and health institutions, which is more cost-effective in resource allocation and use . Besides, primary care programs such as family doctors should be promoted by regional characteristics.
For all ICD-10 categories, the CCE of circulation system is highest, on the one hand, it is related to unhealthy lifestyles, such as smoking, lack of exercise, unbalanced diet and so on, on the other hand, we have to attach importance to the influence of the environment, Although in our knowledge, the environment is often associated with respiratory diseases, studies have shown that the deterioration of environment can increase the incidence of various diseases such as chronic diseases . Therefore, we must pay attention to the environment protection, strengthen the health behaviors throughout the whole life cycle, and establish health programs for key disease populations.
The results of multiple regression analysis showed that drug cost, length of stay, and type of insurance were the main factors affecting CCE. As for drug costs, we should continue to promote the Drug zero markup policy and avoid increasing the medical institution checking cost, medical service cost prices, and the cost of the whole health system . The length of stay can be shortened by improving the efficiency of hospitals . To control health expenses, the hospital should improve the level of diagnosis and treatment levels, and establish common NCDs of the basic norms of evidence-based clinical guidelines . Dalian plans to achieve full medical insurance coverage by 2020. However, this study shows that there is still a gap with this goal. Considering the economic burden and mortality rate of NCDs in all types of diseases, reimbursement rates for NCDs diseases should be increased. For NCDs with high prevalence rate, high treatment frequency, and early control, special compensation schemes should be explored and designed.