School of Health Management, Southern Medical University, 1023 Shatai Road, Baiyun District, Guangzhou, 510000, China.
Department of Healthcare Insurance, Nanfang Hospital, Southern Medical University, Guangzhou, China.
BMC Health Serv Res. 2022 Feb 19;22(1):229. doi: 10.1186/s12913-022-07564-8.
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.
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.
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.
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.
在中国，儿科白血病是最常见的儿童癌症，给患者带来了沉重的经济负担，而他们的保险保障又不足。尽管所有中国儿童都必须参加国家保险计划“城镇居民基本医疗保险（RBMI）”，但这种保护在患者亚组之间可能存在差异。本研究旨在衡量 RBMI 保障下白血病患者的经济负担差异，并探讨其影响因素。
纳入的患者年龄≤15 岁，诊断为急性淋巴细胞白血病（ALL）或急性髓细胞白血病（AML，有/无移植）。他们均于 2015 年 1 月 1 日至 2019 年 12 月 30 日在广州南方医院和珠江医院连续接受治疗。他们的住院治疗和保险结算数据均来自医院信息系统（HIS）和保险结算系统（ISS）。共纳入 765 例连续患者和 14477 份住院病历进行分析。分别计算了他们的保险状态（6 个亚型）、经济负担[总费用、自付费用（OOP）、报销、报销率（RR）]和费用结构（手术/程序、血液制品、药物、简单治疗）。非正态分布的费用以中位数和四分位距（IQR）表示。采用 Wilcoxon 检验进行单变量检验，采用对数链接广义线性模型进行影响因素分析。
即时报销的保险地点治疗的参保患者总费用和报销最高，而无即时报销的跨省份就诊的患者总费用和 OOP 支付最高。从年度变化来看，白血病患儿的总费用从 2015 年至 2019 年呈下降趋势，报销率稳步上升。血液制品和药物是总费用的主要组成部分，但逐年减少。接受移植和跨省份治疗的患者经济负担较高。
在 RBMI 的保护下，白血病患儿的经济负担随时间的推移而降低，但在亚型之间存在差异。支付方-提供方合同中的即时报销和药物费用控制是保险管理者遏制儿科白血病治疗经济负担的有效措施。
