Financial burden of healthcare for cancer patients with social medical insurance: a multi-centered study in urban China

BACKGROUND Cancer accounts for one-fifth of the total deaths in China and brings heavy financial burden to patients and their families. Chinese government has made strong commitment to develop three types of social medical insurance since 1997 and recently, more attempts were invested to provide better financial protection. To analyze health services utilization and financial burden of insured cancer patients, and identify the gaps of financial protection provided by insurance in urban China. METHODS A random sampling, from Urban Employee's Basic Medical Insurance claim database, was performed in 4 cities in 2008 to obtain insurance claim records of cancer patients. Services utilization, medical expenses and out-of-pocket (OOP) payment were the metrics collected from the insurance claim database, and household non-subsistence expenditure were estimated from Health Statistics. Catastrophic health expenditure was defined as household's total out-of-pocket payments exceed 40% of non-subsistence expenditure. Stratified analysis by age groups was performed on service use, expenditure and OOP payment. RESULTS Data on 2091 insured cancer patients were collected. Reimbursement rates were over 80% for Shanghai and Beijing while Fuzhou and Chongqing only covered 60%-70% of total medical expenditure. Shanghai had the highest reimbursement rate (88.2%), high total expenditure ($1228) but lowest OOP payment ($170) among the four cities. Chongqing and Fuzhou's insured cancer patients exclusively preferred tertiary hospitals for outpatient services. Fuzhou led the annual total medical expense ($9963), followed by Chongqing, Beijing and Shanghai. The average OOP as proportion of household's capacity to pay was 87.3% (Chongqing), 66.0% (Fuzhou), 33.7% (Beijing) and 19.6% (Shanghai). Elderly insured cancer patients utilized fewer outpatient services, had lower number of inpatient admissions but longer length of stay, and higher total expenditure. CONCLUSIONS Social economic development was not necessarily associated with total medical expense but determined the level of financial protection. The economic burden of insured cancer patients was reduced by insurance but it is still necessary to provide further financial protections and improve affordability of healthcare for cancer patients in China.