Zhang Yaoyun, He Yu, Wang Qing, Meng Ying, Xia Xinxin, Ji Xiaokang, Zhao Qingbo, Wang Yongchao, Zhao Yifu, Lv Chao, Zhu Liming, Wang Ding, Ling Suping, Xue Fuzhong, Xu Jin
School of Public Health, Peking University, Beijing, China.
China Center for Health Development Studies, Peking University, Beijing, China.
Int J Equity Health. 2025 Jun 5;24(1):163. doi: 10.1186/s12939-025-02533-z.
Tiered social health insurance (SHI) schemes exist in many countries and may lead to significant disparities of healthcare and financial protection. The degree of cancer care inequalities under tiered SHI in China and other low- and middle-income countries (LMICs) remain poorly understood.
We obtained hospital discharged summary for 319,677 patients diagnosed with lung cancer between 2017 and 2021 in Shandong, China, and established propensity score-matched samples under the Urban and Rural Resident Basic Medical Insurance (URRBMI) and those under the Urban Employee Basic Medical Insurance (UEBMI). We ran multivariable regressions to assess the effects of SHI schemes on cancer treatment and expenditures. Subgroup analyses of cancer treatment were conducted based on whether the cancer had metastasized.
In the matched samples, utilization of inpatient cancer care increased under both schemes from 2017 to 2021. Higher proportions of inpatient cancer care utilization were seen in those under UEBMI compared those under URRBMI, consistently with statistical significance. UEBMI was associated with a higher probability of receiving surgery in patients without metastasis, and higher probabilities of receiving radiotherapy or chemotherapy, targeted therapy, and immunotherapy in patients with metastasis. Patients under UEBMI were also less likely to be discharged against medical advice than those under URRBMI. Furthermore, UEBMI beneficiaries had 13.3% higher total expenditures but 19.1% lower out-of-pocket expenditures.
Significant gaps remained in access to inpatient treatment and financial protection for lung cancer, particularly in surgery for non-metastatic cancer. Targeted harmonization of benefit packages is needed to address pressing disparities in cancer care in LMICs with tiered SHI.
The online version contains supplementary material available at 10.1186/s12939-025-02533-z.
许多国家都存在分层社会医疗保险（SHI）计划，这可能导致医疗保健和经济保护方面的显著差异。在中国和其他低收入和中等收入国家（LMICs），分层SHI下的癌症护理不平等程度仍知之甚少。
我们获取了2017年至2021年期间在中国山东省被诊断为肺癌的319,677名患者的医院出院小结，并建立了城乡居民基本医疗保险（URRBMI）参保者和城镇职工基本医疗保险（UEBMI）参保者的倾向得分匹配样本。我们进行了多变量回归分析，以评估SHI计划对癌症治疗和支出的影响。根据癌症是否转移对癌症治疗进行亚组分析。
在匹配样本中，2017年至2021年期间，两种保险计划下的住院癌症护理利用率均有所提高。与URRBMI参保者相比，UEBMI参保者的住院癌症护理利用率更高，且具有统计学意义。UEBMI与未转移患者接受手术的可能性更高以及转移患者接受放疗或化疗、靶向治疗和免疫治疗的可能性更高相关。与URRBMI参保者相比，UEBMI参保者也更不容易违反医嘱出院。此外，UEBMI受益人的总支出高出13.3%，但自付费用低19.1%。
在肺癌住院治疗和经济保护方面仍存在显著差距，尤其是在非转移性癌症的手术治疗方面。需要有针对性地统一福利套餐，以解决分层SHI的LMICs中癌症护理方面的紧迫差异。
在线版本包含可在10.1186/s12939-025-02533-z获取的补充材料。
