How Public Health Insurance Coverage Of Novel Anti-Cancer Medicines Benefit Patients

ObjectiveTo analyze how the basic health insurance coverage of the novel anti-cancer medicines benefit cancer patients,and the associated factors of the proportionate patient out-of-pocket payment of cancer treatment,and to identify the problems in the policy implementation process as well as the policy recommendations for solutions.The study aimed to generate evidence for the formulation of a more equitable and efficient basic health insurance coverage policy to improve the overall social welfare.MethodsThis is a retrospective study based on the health insurance claim data of Fuzhou Healthcare Security Administration.It targets the epidermal growth factor receptor(EGFR)mutated non-small cell lung cancer(NSCLC)and the human epidermal growth factor receptor 2(HER2)breast cancer,and the respective novel medicines newly covered by the basic health insurance program of Fujian province through the national medicines price negotiation.It firstly conducted descriptive analyses of the change of the number of the target patients who had ever adopted the study medicines during January 2016 to December 2018.Longitudinal studies with the segmented linear regression model were followed to measure the level and trend changes of the monthly number of patients to initiate the treatment with the study medicines before and after the health insurance coverage policy.The study also performed multivariate linear regression analyses of the associated factors that determined the proportionate patient out-of-pocket(OOP)cancer-related medical expenditures for the maintenance treatment.The study sorts out related policies and the specific local health insurance policies.It summarizes the implementation progress of the basic health insurance coverage policies of the novel anti-cancer medicines through the national medicines price negotiations.This study also conducted semi-structured interviews with the health insurance policy makers at both central and local levels,medical staff,hospital administrators,pharmaceutical company managers and the cancer patients.Through which,the study summarized the problems in the implementation process in the research target areas,and proposed policy recommendations to address the above problems.ResultsQuantitative research results showed that the number of the non-employed urban and rural resident patients to adopt the study medicines for maintenance anti-lung-cancer treatment increased significantly after the implementation of the health insurance coverage of the study medicines.Before the health insurance coverage,there was always a very small number of the study patients to adopt the study medicines for anti-lung-cancer maintenance treatment.The monthly number of the study lung-cancer patients to initiate the maintenance treatment with the study medicines abruptly increased 26(95%CI:14-37,P<0.01)in the month immediately followed the implementation of the health insurance coverage policy in January 2017,and kept at an increasing level afterwards(P<0.01).By controlling the other factors,the patient OOP share of all the lung cancer-related medical expenditures for maintenance treatment of the public sector staff entitled with the government budget funded supplementary health insurance was lower than that of the patients enrolled in all the other health insurance programs(P<0.01),and 76%lower than the patients enrolled in the urban and rural resident health insurance program(95%CI:59%-91%,P<0.01);the patient OOP share of all the lung cancer-related medical expenditures for maintenance treatment of the retried patients was 22%lower than that of the formal employed patient(95%CI:-37%～-7%,P<0.01).The number of all sorts of breast-cancer patients increased after the insurance coverage.The monthly number of the study patients with breast-cancer increased 24(95%CI:12-36,P<0.01)in the first month that the study medicines was covered by the basic health insurance program of Fuzhou city,and kept at a statistically increased trend afterwards(P=0.02).By controlling the other factors,the proportionate OOP expenditures for a standard course of treatment of the HER2 positive breast cancer patients enrolled in the urban and rural residents health insurance program were 101%(95%CI:75%～128%,P<0.01)higher than that of the patients who were public sector staff and entitled with the government budget funded supplementary health insurance coverage.The semi-structured patient interview proved the results of the above quantitative analyses.Patients generally gained benefits from the public health insurance coverage of novel anti-cancer medicines.However,there were quite a number of the interviewed patients had to pay the treatment from borrowing money,who strongly expected to have their individual financial medical burden of the novel anti-cancer medicines further relieved.The problems in the implementation process of this policy include hospital performance evaluation indicators which restricted the procurement and clinical use of the insurance newly covered novel anti-cancer medicines,complicated procedures of procurement and clinical use applications,and poor capacity of the health facilities below the tertiary specialist hospitals,etc.ConclusionsThe basic health insurance coverage of novel anti-cancer medicines significantly increased the utilization of the study medicines,and benefited the study patients overall.However,the rural and urban resident patients with relatively lower ability-to-pay and weaker basic health insurance reimbursement benefit package benefited less from the policy.To enable that patients benefit from the basic health insurance coverage policy more equally and thoroughly,and to improve the overall social welfare.It is necessary to strengthen the basic health insurance benefit package of them,to narrow the gaps of the benefits packages among different populations,to construct muti-level health security system,and to strengthen the "safety net" for the patients in financial hardship.To have the basic health insurance coverage of novel anti-cancer medicines benefit broader patients well,it is also necessary to enhance the coordination among the regulation policies of the cancer prevention and treatment service delivers,and to have the tertiary cancer specialist hospitals as a lead to construct the regional medical groups with tight collaborations for cancer prevention and treatment.