Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia.
WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Victoria 3010, Australia.
Int J Environ Res Public Health. 2020 Feb 19;17(4):1327. doi: 10.3390/ijerph17041327.
This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE.
We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE.
The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas.
Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.
本研究旨在：(1) 评估中国癌症患者在医疗保健使用和灾难性医疗支出（ CHE ）方面的社会经济差异， CHE 定义为家庭年度医疗支出超过非食品家庭消费支出的 40%；(2) 检验不同癌症治疗方法与卫生服务利用和 CHE 的关系。
我们使用了 2015 年中国健康与退休纵向研究的全国代表性数据，其中包括 17018 名参与者，其中 381 名患有医生诊断的癌症。癌症的主要治疗方法包括中药（ TCM ）、西药（指除 TCM 和其他癌症治疗方法外的西药）、手术和放化疗。集中曲线用于评估医疗保健和 CHE 方面的经济相关差异。多变量回归模型用于检验癌症治疗对卫生服务利用和 CHE 发生率的影响。
2015 年，主要癌症治疗方法和卫生服务利用更多地集中在富裕患者中，而不是贫困患者中。癌症治疗与门诊就诊（调整后的优势比（ AOR ）= 2.492，95%可信区间（ CI ）= 1.506，4.125）、住院治疗（ AOR = 1.817，95% CI = 1.098，3.007）和 CHE （ AOR = 2.744，95% CI = 1.578，4.772）呈正相关。除药物治疗外，所有癌症治疗方法均与 CHE 发生率升高有关，尤其是手术治疗（ AOR = 6.05，95% CI = 3.393，27.866）在城市地区。
中国癌症患者在治疗和卫生服务利用方面的差异在很大程度上取决于经济能力。目前的保险计划不足以解决这些差异。对于中国癌症成年人来说，扩大现有福利套餐和加强公共医疗援助系统的综合健康保险政策是必要的。
