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The economic burden of malaria inpatients and its determinants during China's elimination stage

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Fangfei Chen, Xiaoyu Chen, Peng Gu, Xiaodong Sang, Ruijun Wu, Miaomiao Tian, Eason Ye, Chengxu Long, Ghose Bishwajit, Lu Ji, Da Feng, Lei Yang, Shangfeng Tang

Original languageEnglish
Article number994529
JournalFrontiers in Public Health
Published28 Oct 2022

Bibliographical note

Funding Information: This study was supported by the Natural Science Foundation of Beijing Municipality for Young Scientists-Research on the Quality of Service and Joint Epidemic Prevention Mechanism of Family Doctors Contracted Service in Beijing from the Perspective of Medical-Prevention Integration (Grant No. 9214026) and the National Science Foundation of China-Research on the Value Coupling Mechanism and Model Optimization Strategy of Integrated Community Medical and Elderly Care in China (Grant number 72004073). Funding Information: We would like to thank the solid support from the Disease Prevention and Control Bureau, National Health Commission of the People's Republic of China. For the data collection, we would also like to acknowledge the Center for Diseases Control and Prevention in Zhejiang, Jiangsu, Anhui, Henan, Yunnan, and Sichuan. Publisher Copyright: Copyright © 2022 Chen, Chen, Gu, Sang, Wu, Tian, Ye, Long, Bishwajit, Ji, Feng, Yang and Tang.

King's Authors


Background: Malaria burden is still worrisome, while empirical evidence from malaria-eliminated countries including China may provide inspiration for the world. Objective: This study aimed to investigate China's malaria hospitalization costs and explore its determinants. Methods: Stratified multistage sampling across provincial, municipal, and county hospitals was conducted in 2017. All the malaria medical records were retrieved from 2014 to 2016 in 70 hospitals. Parametric and non-parametric methods were employed to estimate hospitalization costs, and the non-parametric bootstrap was used to compare hospitalization costs among sample areas and assessed the uncertainty of its differences. Quantile regressions were conducted to identify the determinants of hospitalization costs. Results: The median hospitalization costs of 1633 malaria inpatients were 628 USD. Medication and laboratory tests accounted for over 70% of total expenditure. The median reimbursement rate was 41.87%, and this number was even lower in higher-level hospitals (<35%) and among the New Rural Cooperative Medical Scheme (<40%). Finally, health insurance type, hospital tier, clinical units, unknown fever, and comorbidity were the main determinants of hospitalization costs. Conclusion: The disparity of health protection for malaria hospitalization between rural and urban areas was noteworthy. Equivocal diagnosis and comorbidity are contributors of high cost as well. A reasonable payment system and enhanced capacities to treat malaria in a cost-effective way are suggested to reassure malaria economic burden.

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