West China Second University Hospital, Sichuan University, Chengdu, China.
Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.
BMC Health Serv Res. 2022 May 7;22(1):612. doi: 10.1186/s12913-022-07957-9.
Health insurance plays a significant role in reducing the financial burden for lung cancer patients. However, limited research exists regarding the differences in medical costs for lung cancer patients with different insurance schemes across different cities. We aimed to assess disparities in lung cancer patients' costs by insurance type and city-specific insurance type.
Claim data of China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) between 2010 and 2016 were employed to investigate differences in medical costs. This study primarily applied descriptive analysis and a generalized linear model with a gamma distribution and a log link.
In total, 92,856 lung cancer patients with inpatient records were identified, with Renminbi (RMB) 11,276 [6322-20,850] (median [interquartile range]) medical costs for the UEBMI group and RMB 8303 [4492-14,823] for the URBMI group. Out-of-pocket (OOP) expenses for the UEBMI group was RMB 2143 [1108-4506] and RMB 2975 [1367-6275] for the URBMI group. The UEBMI group also had significantly higher drug costs, medical service costs, and medical consumable costs, compared to the URBMI group. Regarding city-specific insurances, medical costs for the UEBMI and the URBMI lung cancer patients in Shanghai were RMB 9771 [5183-16,623] and RMB 9741 [5924-16,067], respectively. In Xianyang, the medical costs for UEBMI and URBMI patients were RMB 11,398 [6880-20,648] and RMB 9853 [5370-24,674], respectively. The regression results showed that the UEBMI group had 27.31% fewer OOP expenses than the URBMI group did, while patients in Xiangyang and Xianyang had 39.53 and 35.53% fewer OOP expenses, respectively, compared to patients in Shanghai.
Compared with the URBMI patients, the UEBMI lung cancer patients obtained more or even better health services and had reduced financial burden. The differences in insurances among cities were greater, compared to those among insurances within cities, and the differences in OOP expenses between cities were greater compared to those between UEBMI and URBMI. Our results called for further reform of China's fragmented insurance schemes.
医疗保险在减轻肺癌患者的经济负担方面发挥着重要作用。然而，针对不同城市、不同医疗保险方案的肺癌患者医疗费用差异的研究较少。本研究旨在评估不同保险类型和按城市划分的保险类型的肺癌患者费用差异。
本研究使用了中国城镇职工基本医疗保险（UEBMI）和城镇居民基本医疗保险（URBMI）2010 年至 2016 年的理赔数据，调查了医疗费用的差异。本研究主要采用描述性分析和广义线性模型，采用伽马分布和对数链接。
共纳入 92856 例肺癌住院患者，UEBMI 组的医疗费用为 11276 元[6322-20850]（中位数[四分位间距]），URBMI 组为 8303 元[4492-14823]。UEBMI 组的自付费用为 2143 元[1108-4506]，URBMI 组为 2975 元[1367-6275]。与 URBMI 组相比，UEBMI 组的药物、医疗服务和医疗耗材费用显著更高。对于特定城市的保险，上海的 UEBMI 和 URBMI 肺癌患者的医疗费用分别为 9771 元[5183-16623]和 9741 元[5924-16067]，咸阳的 UEBMI 和 URBMI 患者的医疗费用分别为 11398 元[6880-20648]和 9853 元[5370-24674]。回归结果显示，UEBMI 组的自付费用比 URBMI 组低 27.31%，而襄阳和咸阳的患者的自付费用比上海的患者分别低 39.53%和 35.53%。
与 URBMI 患者相比，UEBMI 肺癌患者获得了更多甚至更好的医疗服务，并且经济负担减轻。与城市内的医疗保险相比，城市间的医疗保险差异更大，城市间的自付费用差异也大于 UEBMI 和 URBMI 之间的差异。我们的研究结果呼吁进一步改革中国碎片化的医疗保险体系。
