Impacts Of Basic Medical Insurance System On Disease Burden For Patients With Cancer

Improving the medical and health inequity is the major challenge for countries in the world.Over the past decade,the basic medical insurance in China has successfully transformed from "Ternary System" to "Binary System",and the critical illness insurance has been also established to further reduce financial burden for urban and rural residents and improve the equity of medical insurance.However,it has not been extensively studied whether these two major initiatives have achieved the goals.This population-based study was conducted using data obtained from the Basic Medical Insurance claims database(2008-2017)in Tianjin,taking hepatocellular carcinoma(HCC)as an example,to examine the impact of the binary basic medical insurance including Urban Employee Basic Medical Insurance(UEBMI)and Urban and Rural Residents Basic Medical Insurance(URRBMI),as well as the critical illness insurance schemes on the disease burden of cancer,which may inform resource allocation decisions and improving the equity of medical insurance.Firstly,this study reported the epidemiological and economic burden of HCC in Chinese mainland and its temporal trend in the past decade for the first time based on Joinpoint regression,taking Tianjin City as an example.It was found that the incidence and mortality of HCC in Chinese mainland was higher than that in other countries or areas,especially among males and the elderly.And the hospitalization rates had decreased with more and more patients visited the special outpatients in Tianjin,but the total annual costs for HCC patients had not changed significantly over the past decade.Secondly,this study further examined the impact of insurance status on the disease burden during the follow-up period and lifetime based on newly diagnosed patients with HCC using Kaplan-Meier,Cox proportional hazard models,Kaplan-Meier sample average method,phase-of-care approach and propensity score matching.It was found that HCC patients covered by URRBMI had higher risk of death,and were also associated with much more hospitalization,fewer outpatient visits,fewer medical total costs,but higher out-of-pocked rates compared with UEBMI after adjustments for the measured confounders.Lastly,this study using difference in difference,propensity score regression and other statistic methods found that the critical illness insurance had not reduced the disease burden of patients enrolled in URRBMI but had decreased the disparities in healthcare resource use with UEBMI and improved the equity of medical insurance in China.Based on the findings in this study,the government should enhance financial protection for URRBMI and design the scientific deductible and reimbursement rate of the critical illness insurance to improve equity of medical insurance in China.In addition,the government should also strengthen the regular screening and monitoring for high-risk individuals and introduce national-level policies or guidance to promote physical examination for enrollees in URRBMI to improve the health awareness and avoid the occurrence of "a minor illness is incurable,but a serious one is difficult to cure".