Situation analysis of the utilization of health care and medical expenditure for breast cancer patients with different kinds of basic health insurance in 2022: a city in central China as an example

Abstract

Background: Breast cancer ranks as the most prevalent malignancy among Chinese women, constituting approximately 12.2% of all newly diagnosed cases globally. Furthermore, breast cancer imposes substantial economic expenditure on patients in China. From 2012 to 2014, the average expenditure for Chinese breast cancer patients amounted to $8,450, with medical costs constituting a significant proportion of this expenditure. To address the economic vulnerabilities inherent in accessing medical and healthcare services for cancer patients, China has implemented various fundamental medical insurance schemes since 1998. However, previous research lacks an analysis on outpatient services for breast cancer patients and qualitative data interpretation. Therefore, this study aims to analyze the disparities in the utilization of health care and medical expenditure among breast cancer patients under different basic medical insurance schemes in a city in 2022, while also providing qualitative interview data to interpret quantitative findings.Method: This study employs a mixed-method encompassing quantitative and qualitative analyses. The quantitative analysis data originates from the medical insurance settlement data of the city, and analysis is conducted on breast cancer patients who sought diagnosis and treatment for breast cancer in 2022 among the population participating in the basic medical insurance of the city after obtaining permission from the municipal medical insurance bureau. Quantitative analysis encompasses the analysis of the characteristics of these patients, as well as an evaluation of the utilization of health care parameters. These parameters include outpatient visits, the number of hospital admissions, length of stay (LOS), and LOS per admission. Additionally, the analysis extends to the domain of medical expenditure, encompassing total health expenditure, reimbursed expenses from health insurance, out-of-pocket expenses (OOPs), the percentage of OOPs, and the proportion of OOPs relative to individuals' disposable income of this city as a substitution, rather than the individual income of research participants, to estimate the economic burden for breast cancer patients. Qualitative analysis involves conducting interviews with breast cancer treating doctors from a general hospital capable of treating breast cancer, and a personnel from the hospital's medical insurance office, and officials from the city's medical insurance bureau. The aim is to explore the underlying reasons for the observed disparities in quantitative analysis results and seek insights and perspectives from these stakeholders. Result: In a cohort of 550 breast cancer patients subjected to quantitative analysis, 339 were identified as recipients of coverage under the Urban Employee Basic Medical Insurance (UEBMI), with the remaining 211 falling under the Urban and Rural Resident Basic Medical Insurance (URRBMI). Regarding reimbursement policies, UEBMI breast cancer patients demonstrate a higher reimbursement proportion than those covered by URRBMI. UEBMI provides a reimbursement range of 87% to 97% for general inpatient expenses, while URRBMI offers a comparatively lower range of 65% to 80%. Furthermore, in terms of outpatient services, UEBMI presents an 80% reimbursement proportion, surpassing URRBMI, which provides a lower reimbursement proportion of 60%. Quantitative analysis demonstrates that UEBMI breast cancer patients utilize outpatient care, general inpatient care, and combined outpatient and inpatient care significantly more than those covered by URRBMI, with P values all <0.05. Conversely, URRBMI breast cancer patients display a significantly higher utilization in intermittent inpatient care and combined general inpatient with intermittent inpatient care compared to UEBMI patients, with P values all <0.05. Additionally, breast cancer patients under the URRBMI exhibit a significantly higher average number of hospitalizations (4.79) compared to those under the UEBMI (3.64). Moreover, URRBMI breast cancer patients experience a markedly lower average LOS (30.90 days) for combined general and intermittent inpatient services, in contrast to UEBMI patients (57.69 days). The average outpatient visits for UEBMI breast cancer patients are significantly higher across existing combined outpatient and inpatient care, and outpatient combined with general inpatient and intermittent inpatient services, with numbers of 3.21 and 4.11 respectively, compared to URRBMI breast cancer patients, where the number are 1.98 and 2.11. Analysis of medical expenses among breast cancer patients indicates that, despite those covered by URRBMI incurring higher total medical expenditure compared to those under UEBMI, OOPs for UEBMI breast cancer patients are notably lower (8432.43 RMB) than those covered by URRBMI (16603.44 RMB). Furthermore, OOPs for breast cancer patients under UEBMI and URRBMI accounted for 18.16% and 81.94% of their respective per capita disposable incomes. Moreover, concerning combined outpatient and intermittent inpatient services for UEBMI breast cancer patients, outpatient care constitutes 60.09% of the total medical expenditure, exceeding inpatient expenses which comprise 39.91%. Additionally, qualitative analysis indicates that disparities in the quantitative analysis results are primarily attributed to variations in the covered medical services and differences in outpatient and inpatient medication, external drug usage, and requirements of drug proportions, leading to disparities in medical services provided to breast cancer patients by doctors. Moreover, interviewees emphasized the need to improve commercial health insurance coverage, intensify breast cancer screening initiatives, and incorporate a variety of breast cancer treatment drugs into existing centralized procurement policies. Conclusion: The results of this study indicate that breast cancer patients covered by URRBMI face a significant economic burden when seeking medical services, compared to those covered by UEBMI.