韩国国家医疗保险政策的变化与韩国乳腺癌手术趋势。
Changes in Korean National Healthcare Insurance Policy and Breast Cancer Surgery Trend in Korea.
机构信息
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Riyadh, Saudi Arabia.
出版信息
J Korean Med Sci. 2021 Jul 26;36(29):e194. doi: 10.3346/jkms.2021.36.e194.
BACKGROUND
Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM).
METHODS
We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into "uninsured" and "insured" groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR.
RESULTS
Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38-48] vs. 45 [40-50] years; < 0.001). Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy ( = 0.011), adjuvant radiotherapy ( < 0.001), and IBR with tissue expander insertion ( = 0.005) compared with those uninsured.
CONCLUSION
IBR rate in patients undergoing TM increased after NHI reimbursement.
背景
自 2015 年 4 月起，韩国国家健康保险（NHI）开始为乳腺癌患者报销约 50%的乳房重建（BR）费用。我们旨在研究 NHI 报销政策对全乳切除术（TM）后即刻 BR（IBR）率的影响。
方法
我们回顾性分析了 2011 年 4 月至 2016 年 6 月间的乳腺癌数据。我们根据手术时的 NHI 状态，将接受 TM 后 IBR 的乳腺癌患者分为“未参保”和“参保”两组。单变量分析确定了保险对接受 IBR 决定的影响。
结果
在 2897 例乳腺癌患者中，未参保患者（n = 625）行 IBR 的比例低于参保患者（n = 325）（30.0% vs. 39.8%，<0.001）。未参保患者比参保患者年轻（中位数[范围]，43[38-48]岁 vs. 45[40-50]岁；<0.001）。两组患者的病理乳腺癌分期无差异（P = 0.383）。与未参保患者相比，更多参保患者接受了新辅助化疗（ = 0.011）、辅助放疗（<0.001）和带组织扩张器插入的 IBR（ = 0.005）。
结论
NHI 报销后，接受 TM 的患者行 IBR 的比例增加。
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