Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study

Abstract

Background Disparities in the utilization, expenditures, and quality of care by insurance types have been well documented. Such comparisons have yet to be investigated in end-of-life (EOL) settings in China, where public insurance covers over 95% of the Chinese population. This study examined the associations between health insurance and EOL care in the last six months of life: outpatient visits, emergency department (ED) visits, inpatient services, intensive care unit (ICU) admissions, expenditures, and place of death among the cancer patients. Methods A total of 398 patients diagnosed with cancer who survived more than 6 months after diagnosis and died from July 2015 to June 2017 in urban Yichang, China, were included. Descriptive analysis and multivariate regression models were used to investigate the bivariate and independent associations, respectively, between health insurance with EOL healthcare utilization, expenditures and place of death. Results Urban Employee Basic Medical Insurance (UEBMI) beneficiaries visited EDs more frequently than Urban Resident-based Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS) beneficiaries (marginal effects [95% Confidence Interval]: 2.15 [1.81–2.48] and 1.92 [1.59–2.26], respectively). NRCMS and UEBMI beneficiaries had more hospitalizations than URBMI beneficiaries (1.01 [0.38–1.64] and 0.71 [0.20–1.22], respectively). Compared to URBMI beneficiaries, NRCMS beneficiaries and UEBMI beneficiaries had ¥15,722 and ¥43,241 higher expenditures. Similarly, UEBMI beneficiaries were most likely to die in hospitals, followed by NRCMS (UEBMI vs. NRCMS: 0.23 [0.11–0.36]) and URBMI (UEBMI vs. URBMI: 0.67 [0.57–0.78]) beneficiaries. Conclusions The disproportionately lower utilization of EOL care among NRCMS and URBMI beneficiaries, compared to UEBMI beneficiaries, raised concerns regarding quality of EOL care and financial burdens of NRCMS and URBMI beneficiaries. Purposive hospice care intervention might be warranted to address EOL care for these beneficiaries in China.

Place of death and phenomenon of going home to die in Chinese adults: A prospective cohort study

“…Our findings might be helpful for low-and-middle-income countries with similar disparities between HI schemes, especially East and Southeast Asia populations who share a common attitude towards EOL care [34]. Further investigation is needed to improve the equity of EOL care utilization from the perspective of HI, reimbursement policy in particular [19]. We found that the proportion of deaths that occurred in the ER or on the way to the hospital showed a declined trend, which might be related to the improved accessibility of medical facilities [15], as well as the enhanced awareness of timely medical visit of patients.…”

“… 34 Further investigation is needed to improve the equity of EOL care utilization from the perspective of HI, reimbursement policy in particular. 19 …”

“… 18 However, with the expansion of hospital beds, little is known about changes in EOL care, especially about the occurrence of GHTD. It is also important and urgent to know whether the inequalities in EOL care between different HI schemes exist in the general Chinese population for delivering effective and sustainable EOL care services, 1 19 considering the accelerated population ageing in China.…”

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

“…UEBMI had a greater reimbursement rate than other health insurance schemes. The UEBMI beneficiaries were more willing to use expensive drugs and medical compared to the URBMI and NRCMS cancer patients ( 42 ). Evidence from an community-based study in China has confirmed that, in order to lessen the compensation gap between different insurances, the expansion of benefits packages should be tailored to differences between cancer patients in terms of income, health needs, and other factors ( 32 ).…”

Availability of family care resources, type of primary caregiving and home death among the oldest-old: A population-based retrospective cohort study in China

“…Prior studies reported that home was the most common place of death (D. Gu et al, 2007 ; Weng et al, 2021 ; Weng et al, 2018 ). One previous study showed that home is the most preferred place of death among terminal-stage cancer patients in China ( Gu et al, 2015 ), while evidence showed that over 60% of cancer patients died at hospitals in China ( Li et al, 2020a , 2020b ).…”