Impact of the income-based health service types on survival in patients with metastatic gastric cancer

Abstract

e17574 Background: Subscription to National Health Insurance (NHI) is a national obligation for South Korean people. For low-income citizens (about lower 3% of population), Medicaid is applied. Many recipients of Medicaid are vulnerable people such as old age singles, the homeless or the handicapped. These populations are suspected to have worse prognosis. According to one report, on the other hand, patients with Medicaid were more likely to receive chemotherapy than patients with NHI despite the uniform health insurance coverage within the two types of health cost financing. Owing to these conflicting findings, we investigated the relationship between health insurance type and prognosis. Methods: Patients are stage IV advanced gastric cancer patients who received palliative chemotherapy. Medical records were reviewed from January 2006 to November 2008 in Seoul Medical Center (municipal teaching hospital). Results: Total 37 patients were found. Median age was 61 years (range 31–85) and male constituted 75.7%. Platinum (cisplatin or oxaliplatin) combined with 5-FU was the most frequently used regimen (78.4%). Twelve patients (32.4%) were recipients of Medicaid. Median PFS and OS of NHI group were 6.9 (95% CI, 1.7–12.0) and 7.8 (95% CI, 3.4–12.1). And that of Medicaid were 5.6 (95% CI, 2.6–8.6) and 7.8 (95% CI, 3.4–12.2) months. The difference from two groups were not statistically different (p = 0.739 for PFS and 0.466 for OS). When patients were divided into longer or shorter survivors according to mean OS (14.1 ±2.6 months), NHI recipients had more probability for survival (odds ratio 0.72, 95% CI 0.56–0.92). Conclusions: The question is raised whether recipients of Medicaid have poorer prognosis than patients with NHI in metastatic gastric cancer in South Korea. Although it seems that NHI recipients has better prognosis, still we cannot sure. It should be cleared in large scale cohort study whether this is related to low socio-economic status or other uncontrolled confounder. No significant financial relationships to disclose.