Background Ningxia is located in western People's Republic of China, which is hyperendemic for human cystic echinococcosis (CE) throughout the entire area with alveolar echinococcosis (AE) hyperendemic in the south. This is in part due to its underdeveloped economy. Despite the recent rapid growth in P.R. China's economy, medical expenditure for hospitalization of echinococcosis cases has become one of the major poverty generators in rural Ningxia, resulting in a significant social problem. Methodology/Principal Findings We reviewed the 2000 inpatient records with liver CE in surgical departments of hospitals from north, central and south Ningxia for the period 1996–2002. We carried out an analysis of health care expenditure of inpatient treatment in public hospitals, and examined the financial inequalities relating to human echinococcosis and the variation in per capita income between various socioeconomic groups with different levels of gross domestic product for different years. Hospital charges for Yinchuan, NHAR's capital city in the north, increased approximately 35-fold more than the annual income of rural farmers with the result that they preferred to seek health care in local county hospitals, despite higher quality and more efficient treatment and diagnosis available in the city. Household income levels thus strongly influenced the choice of health care provider and the additional expense impeded access of poor people to better quality treatment. Conclusions/Significance Information on socioeconomic problems arising from echinococcosis, which adds considerably to the burden on patient families and communities, needs to be collected as a prerequisite for developing policies to tackle the disease in rural Ningxia.
References
[1]
Liu X, Liu Y, Chen N (2000) The Chinese experience of hospital price regulation. Health Policy Plan 15: 157–163. doi: 10.1093/heapol/15.2.157
[2]
Liu Y, Rao K, Hsiao WC (2003) Medical expenditure and rural impoverishment in China. J Health Popul Nutr 21: 216–222.
[3]
Anonymous (1994) Research on national health services-an analysis report of the national health services survey in 1993, Ministry of Health, People's Republic of China, Beijing. pp. 16–28.
[4]
Anonymous (1999) Repots on the 1998 national health services survey results, Ministry of Health, People's Republic of China, Beijing. pp. 22–35.
[5]
Gu X, Bloom G, Tang S, Zhu Y, Zhou S, et al. (1993) Financing health care in rural China: preliminary report of a nationwide study. Soc Sci Med 36: 385–391. doi: 10.1016/0277-9536(93)90400-X
[6]
Hsiao WC (1984) Transformation of health care in China. N Engl J Med 310: 932–936. doi: 10.1056/NEJM198404053101426
[7]
Tang S, Meng Q, Chen L, Bekedam H, Evans T, et al. (2008) Tackling the challenges to health equity in China. Lancet 372: 1493–1501. doi: 10.1016/S0140-6736(08)61364-1
[8]
Feng X, Tang S, Bloom G, Segall M, Gu Y (1995) Cooperative medical schemes in contemporary rural China. Soc Sci Med 41: 1111–1118. doi: 10.1016/0277-9536(94)00417-R
[9]
Meng Q, Li R, Cheng G, Blas E (2004) Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, China. Int J Health Plann Manage 19(Suppl 1): S45–62. doi: 10.1002/hpm.774
[10]
Yang YR, Craig PS, Sun T, Vuitton DA, Giraudoux P, et al. (2008) Echinococcosis in Ningxia Hui Autonomous Region, northwest China. Trans R Soc Trop Med Hyg 102: 319–328. doi: 10.1016/j.trstmh.2008.01.007
[11]
Yang YR, Sun T, Li Z, Li X, Zhao R, et al. (2005) Echinococcosis, Ningxia, China. Emerg Infect Dis 11: 1314–1316. doi: 10.3201/eid1108.041179
[12]
Yang YR, Sun T, Li Z, Zhang J, Teng J, et al. (2006) Community surveys and risk factor analysis of human alveolar and cystic echinococcosis in Ningxia Hui Autonomous Region, China. Bull World Health Organ 84: 714–721. doi: 10.2471/BLT.05.025718
[13]
Anonymous (2004) Economic development.
[14]
Anonymous (2001) Major Figures on 2000 Population census of China. China Statistics Press, Beijing.
[15]
McIntyre D, Thiede M, Dahlgren G, Whitehead M (2006) What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? Soc Sci Med 62: 858–865. doi: 10.1016/j.socscimed.2005.07.001
[16]
Yang YR, Cheng L, Yang SK, Pan X, Sun T, et al. (2006) A hospital-based retrospective survey of human cystic and alveolar echinococcosis in Ningxia Hui Autonomous Region, PR China. Acta Trop 97: 284–291. doi: 10.1016/j.actatropica.2005.12.001
[17]
Yang YR, Williams GM, Craig PS, Sun T, Yang SK, et al. (2006) Hospital and community surveys reveal the severe public health problem and socio-economic impact of human echinococcosis in Ningxia Hui Autonomous Region, China. Trop Med Int Health 11: 880–888. doi: 10.1111/j.1365-3156.2006.01633.x
[18]
Deaton AS, Paxson CH (1997) The effects of economic and population growth on national saving and inequality. Demography 34: 97–114. doi: 10.2307/2061662
[19]
Van Damme W, Van Leemput L, Por I, Hardeman W, Meessen B (2004) Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia. Trop Med Int Health 9: 273–280. doi: 10.1046/j.1365-3156.2003.01189.x
[20]
Whitehead M, Dahlgren G, Evans T (2001) Equity and health sector reforms: can low-income countries escape the medical poverty trap? Lancet 358: 833–836. doi: 10.1016/S0140-6736(01)05975-X
[21]
Yang YR, Craig PS, Vuitton DA, Williams GM, Sun T, et al. (2008) Serological prevalence of echinococcosis and risk factors for infection among children in rural communities of southern Ningxia, China. Trop Med Int Health 13: 1086–1094. doi: 10.1111/j.1365-3156.2008.02101.x
[22]
van Doorslaer E, Masseria C, Koolman X (2006) Inequalities in access to medical care by income in developed countries. CMAJ 174: 177–183. doi: 10.1503/cmaj.050584