Differences in medical costs among urban lung cancer patients with different health insurance schemes: a retrospective study

Abstract

Background Health insurance plays a significant role in reducing the financial burden for lung cancer patients. However, limited research exists regarding the differences in medical costs for lung cancer patients with different insurance schemes across different cities. We aimed to assess disparities in lung cancer patients’ costs by insurance type and city–specific insurance type. Methods Claim data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) between 2010 and 2016 were employed to investigate differences in medical costs. This study primarily applied descriptive analysis and a generalized linear model with a gamma distribution and a log link. Results In total, 92,856 lung cancer patients with inpatient records were identified, with Renminbi (RMB) 11,276 [6322–20,850] (median [interquartile range]) medical costs for the UEBMI group and RMB 8303 [4492–14,823] for the URBMI group. Out–of–pocket (OOP) expenses for the UEBMI group was RMB 2143 [1108–4506] and RMB 2975 [1367–6275] for the URBMI group. The UEBMI group also had significantly higher drug costs, medical service costs, and medical consumable costs, compared to the URBMI group. Regarding city-specific insurances, medical costs for the UEBMI and the URBMI lung cancer patients in Shanghai were RMB 9771 [5183–16,623] and RMB 9741 [5924–16,067], respectively. In Xianyang, the medical costs for UEBMI and URBMI patients were RMB 11,398 [6880–20,648] and RMB 9853 [5370–24,674], respectively. The regression results showed that the UEBMI group had 27.31% fewer OOP expenses than the URBMI group did, while patients in Xiangyang and Xianyang had 39.53 and 35.53% fewer OOP expenses, respectively, compared to patients in Shanghai. Conclusions Compared with the URBMI patients, the UEBMI lung cancer patients obtained more or even better health services and had reduced financial burden. The differences in insurances among cities were greater, compared to those among insurances within cities, and the differences in OOP expenses between cities were greater compared to those between UEBMI and URBMI. Our results called for further reform of China’s fragmented insurance schemes.

Socioeconomic inequality in health care use among cancer patients in China: Evidence from the China health and retirement longitudinal study

“…Therefore, for outpatient utilization, the disparities were relatively small. In addition, from the patients' socioeconomic status perspective, cancer patients who were covered by UEBMI were all urban workers or retired workers, they usually had higher income and better education compared to those with URBMI and NRCMS ( 43 ). Hence, they had a stronger incentive to utilize health care, which led to the significant effect on inequalities of UEBMI.…”

“…Our sample size was relatively small and only included individuals aged ≥45 years. Fourth, since URBMI and NCMS have been merged, a comparison between UEBMI and URRBMI could be a better choice in future research ( 43 ). Finally, quality or efficiency measures should be included in inequality research; unfortunately, our survey did not provide relevant indicators ( 44 ).…”

Adopting social health insurance in Nepal: A mixed study

“…Alternatively, a study carried out among patients with lung cancer in Shanghai and other two cities in China showed that out-of-pocket expenditures (OOP) in two cities were less by more than one-third (36–40%) than that in Shanghai but there were more and better health services in those two cities. Inside the cities, employees had a lesser financial burden, compared to resident city dwellers ( 38 ). Another study from rural Rwanda shows that to pay bills, nearly half of the patients had to borrow money from family or friends, accruing an informal debt that they would have to repay, and 12% had to sell their belongings ( 39 ).…”

Financial toxicity among older cancer survivors in China: a qualitative study of oncology providers’ perceptions and practices

“…As we all know, health insurance plays a major role in reducing the financial burden for patients. There are two basic health insurance schemes in China: Urban Employee Basic Medical Insurance (UEBMI) is eligible for urban workers, and Urban–Rural Resident Basic Medical Insurance (URRBMI) is applicable for unemployed residents in urban areas and rural residents [ 10 ]. Employers and employees pay jointly for premiums of UEBMI.…”

“…Therefore, increasing discussions and expectations are around the oncologists’ pivotal role in preparing patients financially for cancer care [ 17 ]. However, relevant research on the financial toxicity of older cancer survivors is still in the beginning stages in China [ 10 , 13 , 18 , 19 ]. Furthermore, studies have shown that patients desire active advising from their providers regarding their financial concerns [ 20 ].…”