Medical expenditure and its influencing factors of patients with hypertension in Shanxi Province, China: a study based on ‘System of Health Accounts 2011’ and multiple-layer perceptron neural network

Objectives To study the medical expenditure and influencing factors of patients with hypertension in Shanxi Province, China. Design A cross-sectional study. Setting 1088 medical institutions, including general hospitals, traditional Chinese medicine hospitals, special hospitals, basic medical institutions and public health institutions. Participants 180 441 hypertensive outpatients and 14 763 inpatients from 1 January to 31 December 2017. Primary and secondary outcome measures Curative care expenditure for hypertension (CCE ht ) was measured based on System of Health Accounts 2011. Influenced factors were analysed by univariate analysis and multiple layer perceptron neural network. Results In 2017, CCE ht was US$307.71 million, accounting for 3.63% of total CCE and 0.14% of gross domestic product (GDP) in Shanxi Province of China. CCE of hypertensive outpatients (CCE ht-out ) and inpatients (CCE ht-in ) accounted for 44.49% and 55.51% of CCE ht . Drug fee accounted for 81.55% of CCE ht-out and 22.50% of CCE ht-in , respectively. The top three influencing factors were drug fee, surgical fee and hospitalisation days for inpatients, and drug fee, examination fee and test fee for outpatients. Conclusions The medical expenditure of hypertension is still heavy for individuals and society. The diagnosis and treatment capacities of primary healthcare system has been enhanced. New rural cooperation medical insurance and urban employee basic medical insurance have a trend of overusing, and the burden of family healthcare expenditure is still heavy. To ease the economic burden of patients with hypertension and improve the efficiency of social resources utilisation, policymakers should pay more attention to key groups, further increase support for primary healthcare system, standardise the treatment and reimbursement of hypertension and incline the reimbursement policy to outpatient service.