Curative care expenditure across different comorbidity states of chronic hepatitis B: a prevalence study in Sichuan Province, China

Objective The study aims to calculate the curative care expenditure (CCE) from different comorbidity states of chronic hepatitis B (CHB), to provide a reference for the relevant government departments to optimise health insurance protection measures for this disease. Design A prevalence-based retrospective study. Setting This study included 1600 medical institutions, covering general hospitals, traditional Chinese medicine hospitals, specialised hospitals and maternal and child health hospitals. Participants The cohort included 238,617 CHB outpatients and 4312 inpatients. Primary and secondary outcome measures CCE for CHB was estimated based on System of Health Accounts 2011. Results The total CCE of CHB in Sichuan Province in 2019 was USD 85.49 million. The majority of CCE was spent by outpatient services (USD 67.16 million), the main source of financing schemes was household out-of-pocket payment (75.71%). Conversely, the CCE for inpatient services (USD 18.33 million) was mainly financed by public financing schemes (46.38%). More than 70% of the CCE flowed to general hospitals, and less than 20% flowed to primary healthcare institutions. The CCE varied significantly across different comorbidity groups. The CCE for patients with no additional comorbidities and those in the low comorbidity group was mainly spent by patients aged 30–39 years and those aged 40–49 years, respectively. The CCE in the high comorbidity group was mainly spent by patients aged 50–54 years. Conclusion The present study shows that a high proportion of the CCE allotted to CHB is financed by household out-of-pocket payment. This situation poses a heavy medical burden not only on individuals, but also on society. Therefore, the financing structure needs to be optimised urgently. Potential policy directions may improve the outpatient mutual aid protection mechanism.