School of Medicine, Chongqing University, Chongqing, China.
Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China.
Front Public Health. 2023 Jun 2;11:1020828. doi: 10.3389/fpubh.2023.1020828. eCollection 2023.
Health insurance programs are effective in preventing financial hardship in patients with cancer. However, not much is known about how health insurance policies, especially in Southwest China with a high incidence of nasopharyngeal carcinoma (NPC), influence patients' prognosis. Here, we investigated the association of NPC-specific mortality with health insurance types and self-paying rate, and the joint effect of insurance types and self-paying rate.
This prospective cohort study was conducted at a regional medical center for cancer in Southwest China and included 1,635 patients with pathologically confirmed NPC from 2017 to 2019. All patients were followed up until May 31, 2022. We determine the cumulative hazard ratio of all-cause and NPC-specific mortality in the groups of various insurance kinds and the self-paying rate using Cox proportional hazard.
During a median follow-up period of 3.7 years, 249 deaths were recorded, of which 195 deaths were due to NPC. Higher self-paying rate were associated with a 46.6% reduced risk of NPC-specific mortality compared to patients with insufficient self-paying rate (HR: 0.534, 95% CI: 0.339-0.839, = 0.007). For patients covered by Urban and Rural Residents Basic Medical Insurance (URRMBI), and for patients covered by Urban Employee Basic Medical Insurance, each 10% increase in the self-paying rate reduced the probability of NPC-specific death by 28.3 and 25%, respectively (UEBMI).
Results of this study showed that, despite China's medical security administration improved health insurance coverage, NPC patients need to afford the high out-of-pocket medical costs in order to prolong their survival time.
健康保险计划在预防癌症患者经济困难方面非常有效。然而，对于健康保险政策（尤其是在中国西南部鼻咽癌高发地区）如何影响患者预后，我们知之甚少。在这里，我们研究了 NPC 特异性死亡率与健康保险类型和自费率的关系，以及保险类型和自费率的联合作用。
这是一项在中国西南部地区一家肿瘤区域医疗中心进行的前瞻性队列研究，纳入了 2017 年至 2019 年间经病理证实的 1635 例 NPC 患者。所有患者均随访至 2022 年 5 月 31 日。我们使用 Cox 比例风险模型确定了不同保险种类和自费率组的全因死亡率和 NPC 特异性死亡率的累积风险比。
在中位随访 3.7 年期间，记录了 249 例死亡，其中 195 例死于 NPC。与自费率不足的患者相比，自费率较高的患者 NPC 特异性死亡率降低了 46.6%（HR：0.534，95%CI：0.339-0.839， = 0.007）。对于参加城乡居民基本医疗保险（URRMBI）和参加城镇职工基本医疗保险的患者，自费率每增加 10%，NPC 特异性死亡的概率分别降低 28.3%和 25%（UEBMI）。
本研究结果表明，尽管中国的医疗保障管理改善了健康保险的覆盖范围，但 NPC 患者需要支付高昂的自付医疗费用，以延长生存时间。
