The effect of low insurance reimbursement on quality of care for non-small cell lung cancer in China: a comprehensive study covering diagnosis, treatment, and outcomes

Xi Li,Meiqi Zhang,Xinyu Wang,Qi Zhou,Hao Jiang,Shaofei Su,Meina Liu,Jiaying Wang

doi:10.1186/s12885-018-4608-y

Abstract

BackgroundThe insurance reimbursement rate of medical cost affects the quality and quantity of health services provided in China. The nature of this relationship, however, has not been reliably described in the field of non-small cell lung cancer (NSCLC). The objective of the current study was to examine the impact of low reimbursement rates of medical costs on diagnosis, treatment and outcomes among patients with NSCLC.MethodsWe examined care of 2643 NSCLC patients and we divided the study cohort into a high reimbursement rate group and a low reimbursement rate group. The impact of reimbursement rates of medical costs on quality of care of NSCLC patients were examined using logistic regression and generalized linear models.ResultsCompared with patients insured with high reimbursement rate, patients insured through lower reimbursement rate programs were less likely to benefit from early detection and treatment services. Delayed detection was more common in low reimbursement group and they were less likely to be recommended for adjuvant chemotherapy, or to receive adjuvant chemotherapy and postoperative radiation therapy and they had lower odds to receipt chemotherapy response assessment. However, low reimbursement rate group had lower rate of in-hospital mortality and metastases.ConclusionsLow reimbursement rate mainly negatively influenced the diagnosis and treatment of NSCLC. Reducing the gap in reimbursement rate between the three health insurance schemes should be a focus of equalizing access to care and improving the level of medical compliance and finally improving quality of care of NSCLC.

Highlights

The insurance reimbursement rate of medical cost affects the quality and quantity of health services provided in China
Because this study aimed to analyze the influence of low reimbursement rates on quality of care for non-small cell lung cancer (NSCLC), patients with obscure primary payer status and those who self-discharged were not included in the study
Compared with patients insured with high reimbursement rate, underutilization of process-of-care indicators was found among patients insured with low reimbursement rate, who had comparatively lower probability for being recommended for adjuvant chemotherapy (ACT) (37.96% vs. 48.26%, P = 0.0187) or receiving ACT (44.69% vs. 52.24%, P = 0.0484), postoperative radiation therapy (PORT) (0.49% vs. 2.88%, P = 0.0010) or radiographic assessment of chemotherapy response (47.02% vs. 59.41%, P = 0.0014)

Summary

Introduction

The insurance reimbursement rate of medical cost affects the quality and quantity of health services provided in China. The nature of this relationship, has not been reliably described in the field of non-small cell lung cancer (NSCLC). The level of insurance reimbursement of medical costs plays a vital role in determining the quality and quantity of health services provided [1,2,3,4,5,6]. China’s health insurance system is a combination of compulsory and voluntary insurance types It primarily consists of three basic social health insurance programs, which are uniformly government-supported and cover more than 95.7% of the Chinese population [7]. The reimbursement rate for NCMS is 50–65%—much lower than UEBMI’s rate of 85–95% but similar to URBMI’s rate of 50% [6]

Objectives

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Results