中国乳腺癌患者家庭灾难性医疗支出
2021年7月5日，瑞士《公共卫生前沿》在线发表哈尔滨医科大学卫生管理学院刘国祥、中国医学科学院北京协和医学院肿瘤医院国家癌症中心国家肿瘤临床医学研究中心陈万青和赫捷等学者研究报告，分析了中国乳腺癌患者家庭灾难性医疗支出的程度及其影响因素，并探讨了不同医疗保险对这些家庭免受灾难性医疗支出的保护能力。
该研究于2018年1月至2019年6月对中国广东、安徽、黑龙江、山西、广西、云南、内蒙古的639个乳腺癌患者家庭进行多中心横断面访谈调查。灾难性医疗支出被定义为自付医疗费用≥家庭非食品支出的40%。通过卡方检验和多因素逻辑回归模型分析确定乳腺癌患者家庭灾难性医疗支出的影响因素。
结果发现，平均自付医疗费用占家庭平均非食品支出的55.20%。
医疗保险赔付前后，灾难性医疗支出的总发生率分别为87.95%和66.28%。
多因素逻辑回归模型分析表明，灾难性医疗支出发生率显著较高的影响因素包括：
未接受过任何教育（与小学、初中、高中、大学及以上教育相比）
病程1～2年（与<1年相比）
城镇居民基本医疗保险（与职工基本医疗保险相比）
家庭年收入≤8万（与>8万相比）
手术＋化疗（与手术相比）
因此，该研究结果表明，医疗保险可以保护一些乳腺癌家庭免受灾难性医疗支出的影响。不过，其报销率相对较低，故乳腺癌对家庭经济仍然具有显著的灾难性影响。政策应努力集中于提高保险赔付率，减轻乳腺癌等重大疾病的经济负担，尤其对于未接受过任何教育、病程较长、家庭收入水平较低、治疗较多的患者。
Front Public Health. 2021 Jul 5;9:704700.
Catastrophic Health Expenditure and Its Determinants Among Households With Breast Cancer Patients in China: A Multicentre, Cross-Sectional Survey.
Sun CY, Shi JF, Fu WQ, Zhang X, Liu GX, Chen WQ, He J.
College of Health Management of Harbin Medical University, Harbin, China; National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BACKGROUND: Although numerous studies have examined catastrophic health expenditures (CHE) worldwide, most focus on the general population, not on specific vulnerable groups. We aimed to analyse the extent and the influencing factors of CHE in households with breast cancer patients in China, and explore the ability of different insurances to protect these households from CHE.
METHODS: A multicentre, cross-sectional interview surveys was conducted in households with breast cancer patients across seven provinces/municipalities in China. CHE were defined as out-of-pocket expenditures ≥ 40% of households' non-food expenditures. Chi-square tests and logistic regression analysis were performed to identify the determinants of CHE in household with breast cancer patients.
RESULTS: In the 639 participating households with breast cancer patients, the mean out-of-pocket (OOP) expenditure accounted for ~55.20% of the mean households' non-food expenditures. The overall incidence of CHE was 87.95 and 66.28% before and after insurance compensation, respectively. The logistic regression model revealed that education, disease course, health insurance, treatment method, and income were significant predictors of CHE.
CONCLUSIONS: The results indicated that medical insurance protects some households with breast cancer patients from the impact of CHE. However, their reimbursement rates were relatively low. Therefore, breast cancer still had a significant catastrophic effect on the economy of households. Policy efforts should focus on improving insurance compensation rates and relieving the economic burden of critical illnesses such as breast cancer.
KEYWORDS: China; breast cancer; catastrophic health expenditures; economic burden; insurance
PMID: 34291034
PMCID: PMC8287064
DOI: 10.3389/fpubh.2021.704700
