Medical Insurance Payment Schemes and Patient Medical Expenses: A Cross- Sectional Study of Lung Cancer Patients in Urban China

Abstract

Background：As the main cause of cancer death, lung cancer imposes seriously health and economic burdens on individuals, families, and the health system. In China, there is no national study analyzing the hospitalization expenditures of different payment methods by lung cancer inpatients. Based on the 2010-2016 database of insured urban resident lung cancer inpatients from the China Medical Insurance Research Association (CHIRA), this paper examines the differences in hospital expenses and patient out-of-pocket (OOP) expenses under four medical insurance payment methods: fee-for-service (FFS), per-diem payments, capitation payments (CAP) and case-based payments, and then explores the medical insurance payment method most conducive to controlling the cost of lung cancer. Method: This is a 2010-2016, 7-year cross-sectional study. CHIRA data are not available to researchers after 2016. The Medical Insurance Database of CHIRA was screened using the international disease classification system to yield 28200 inpatients diagnosed with lung cancer (ICD-10: C34, C34.0, C34.1, C34.2, C34.3, C34.8, C34.9). The study includes descriptive analysis and regression analysis based on generalized linear models (GLM). Results： The average patient age was 63.4 years and the average length of hospital stay (ALOS) was 14.2 day; 60.7% of patients were from tertiary hospitals; and 45% were insured by FFS. The per-diem payment had the lowest hospital expenses (RMB7496.00/US$1176.87), while CAP had the lowest OOP expenses (RMB1328.18/US$208.52). Compared with FFS hospital expenses, per-diem was 21.3% lower (95% CI=-0.265, -0.215) and case-based payment was 8.4% lower (95% CI=-0.151, -0.024). Compared with the FFS, OOP expenses, per-diem payments were 9.2% lower (95% CI=-0.130, -0.063) and CAP was 15.1% lower (95% CI=-0.151, -0.024). Conclusion：For lung cancer patients, per-diem payment generated the lowest hospital expenses, while CAP meant patients bore the lowest OOP costs. Facing major diseases such as lung cancer, priority should be given to reducing OOP expenses and implementing CAP. But policy makers should also consider case-based payments to achieve a tripartite balance among medical insurers, hospitals, and insured members. We recommend comparative future studies of the impact of medical insurance schemes on patients suffering other diseases.