Disparities in economic burden for children with leukemia insured by resident basic medical insurance: evidence from real-world data 2015–2019 in Guangdong, China

Abstract

Background Pediatric leukemia is the most prevalent childhood cancer in China and incurs heavy economic burden to patients without sufficient insurance protection. Although all Chinese children are obliged to enroll in the national insurance scheme, “Resident Basic Medical Insurance (RBMI)”, the protection may vary among patient subgroups. This study is designed to measure the disparities in economic burden for patients with leukemia under RBMI protection and explore the influencing factors. Methods The included patients were aged ≤ 15 and diagnosed with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML, with/without transplantation). They all completed treatment course consecutively in Nanfang Hospital and Zhujiang Hospital from Jan.1, 2015, to Dec.30, 2019, in Guangzhou, China. Their inpatient treatment and insurance settlement data were drawn from the Hospital Information System (HIS) and Insurance Settlement System (ISS). A total of 765 consecutive patients and 14,477 inpatient medical records were included and analyzed. Their insurance status (6 subtypes), economic burden [total cost, out-of-pocket cost (OOP), reimbursement, reimbursement rate (RR)], and cost structures (operation/procedure, blood products, drug, simple treatment) were calculated respectively. Non-normally distributed costs were reported as the median and interquartile range (IQR). Wilcoxon test was used for univariate tests and generalized linear model with log link was used to explore the influencing factors. Results The insured patients who were treated in the location of insurance with instant reimbursement reported the highest total cost and reimbursement, while those who seek medical care cross-province with no instant reimbursement reported the lowest total cost and highest OOP payment. In terms of annual change, the total cost of children with leukemia decreased from 2015–2019 with stably increasing reimbursement rate. Blood products and drugs were the major components of total cost, but they decreased annually. Patients who received transplantation and treated across provinces were with a higher economic burden. Conclusion The economic burden for children with leukemia decreased overtime under the protection of RBMI, but disparities exist among subtypes. The payer-provider contract on instant reimbursement and drug cost control are effective measures for insurance administrators to curb the economic burdens of pediatric leukemia treatment.

The Impact of Instant Reimbursement of Cross-Regional Medical Services on Hospitalization Costs Incurred by the Floating Population—Evidence from China

“…Based on data retrieved from the instant settlement platform, some scholars compared the changes in medical costs after the implementation of instant settlement, and found that medical costs increased significantly [ 23 , 24 ]. Zhan et al (2022) also found that choosing instant reimbursement significantly improved the total medical cost for children with leukemia [ 25 ]. Moreover, some scholars also compared the utilization difference of health services between local medical treatment and cross-regional medical treatment, and found that the reimbursement rate of health insurance for cross-provincial medical services was significantly lower than that of local residents, which increased the financial burden of cross-regional patients [ 26 ].…”

Cost Drivers and Financial Burden for Cancer-Affected Families in China: A Systematic Review

“…A total of 25 studies reported annual mean costs of cancer treatment [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ], 1 study reported the average monthly medical cost [ 49 ], 1 study reported the average cost of cancer care for 5 years [ 50 ], and 3 studies reported the costs during the illness without specifying the course of treatment [ 51 , 52 , 53 ]. Four studies only reported the median of the costs, which were not included in the data synthesis [ 54 , 55 , 56 , 57 ]. In addition, 2 studies only reported coping strategies [ 58 , 59 ], and 2 reported the proportion of catastrophic expenditure without reporting cost data [ 60 , 61 ].…”

“…In addition, 2 studies only reported coping strategies [ 58 , 59 ], and 2 reported the proportion of catastrophic expenditure without reporting cost data [ 60 , 61 ]. According to the quality assessment for all included studies, 10 studies [ 30 , 41 , 42 , 43 , 44 , 45 , 51 , 55 , 58 , 61 ] were assessed as high quality, 10 studies [ 31 , 32 , 33 , 40 , 46 , 47 , 50 , 56 , 57 , 60 ] at the middle level, and 18 studies [ 25 , 27 , 28 , 34 , 35 , 36 , 37 , 38 , 39 , 48 , 49 , 52 , 53 , 59 ] as low quality.…”

Cost drivers and financial burden for cancer-affected families in China: a systematic review

“…[47][48][49] Four studies only reported the median of the costs which were not included in the data synthesis. [50][51][52][53] In addition, two studies only reported coping strategies 54,55 and two reported the proportion of catastrophic expenditure without reporting cost data. 56,57 According to the quality assessment for all included studies, 10 studies 26, [37][38][39][40][41]47,51,55,56 were assessed as high quality, 10 studies 27-29,36,42,43,46,52−54 at the middle level and 18 studies 21,23,24,[30][31][32][33][34][35]44,45,48,49,57 as low quality.…”