OBJECTIVES: Multiple sclerosis (MS) is a chronic, autoimmune neurologic disorder resulting in substantial economic burden. With cost of illness research on MS being extensively studied worldwide, however, little is known about the equity concern of utilization and reimbursement. This study aimed to evaluate the distribution of utilization, cost, and reimbursement received by MS patients with different socio-economic status (SES) in China.

METHODS: We conducted a benefit incidence analysis using self-reported online survey data from a nationwide MS patient community collected in July 2022. Data were derived from 733 MS patients including demographics, health status, healthcare utilization, and associated costs. We stratified patients using annual household income per capita and calculated concentration index (CI). Direct standardization using self-reported health status was applied in the analysis.

RESULTS: Benefit incidence analysis suggested a pro-rich distribution of utilization and medical reimbursement for MS patients. The average number of outpatient visits was 6.99 (SD=0.96), while the richest quintile had 0.72 more visits than the poorest. The annual direct medical cost per patient was 48,537 RMB (7,205 USD), and the self-reported reimbursement rate was 51.51% (SD=0.05). However, about 48.41% of the medical cost from the poorest quintile was reimbursed compared to 53.76% among the richest quintile. The CI of outpatient visits was 0.03 (p<0.05), showing lower healthcare utilization for poorer patients. Moreover, the CIs of total medical cost and reimbursed cost were 0.06 (p<0.05) and 0.05 (p<0.05), indicating lower total medical expenses amongst poorer patients and higher reimbursement received by more affluent patients.

CONCLUSIONS: Despite the lower medical cost of MS in China compared to most high-income countries, substantial variations exist in utilization and reimbursement received by patients across SES levels. Policymakers should be aware of the inequitable service utilization and reimbursement in MS patients and pay attention to allocation outcomes of public funding among populations.