Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb 19;17(4):1327.
doi: 10.3390/ijerph17041327.

Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

Yang Zhao  1   2 , Lin Zhang  3   4 , Yu Fu  1 , Minyu Wang  5   6   7 , Luwen Zhang  8
Affiliations

Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

Yang Zhao et al. Int J Environ Res Public Health. .

Abstract

Background: This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE.

Methods: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE.

Results: The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas.

Conclusion: Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.

Keywords: China; cancer treatment; catastrophic health expenditure; financial burden; socioeconomic disparities.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Concentration curves of treatments for patients with cancer in China in 2015.
Figure 2
Figure 2
Concentration curves of health service use and expenditure for patients with cancer in China in 2015.
See this image and copyright information in PMC

References

    1. Bray F., Ferlay J., Soerjomataram I., Siegel R., Torre L., Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 2018;68:394–424. doi: 10.3322/caac.21492. - DOI - PubMed
    1. Fang H., Eggleston K., Hanson K., Wu M. Enhancing financial protection under China’s social health insurance to achieve universal health coverage. BMJ. 2019;365:l2378. doi: 10.1136/bmj.l2378. - DOI - PMC - PubMed
    1. Liu H., Gao S., Rizzo J. The expansion of public health insurance and the demand for private health insurance in rural China. China Econ. Rev. 2011;22:28–41. doi: 10.1016/j.chieco.2010.08.006. - DOI
    1. Mao W., Tang S., Zhu Y., Xie Z., Chen W. Financial burden of healthcare for cancer patients with social medical insurance: A multi-centered study in urban China. Int. J. Equity Health. 2017;16:180. doi: 10.1186/s12939-017-0675-y. - DOI - PMC - PubMed
    1. Meng Q., Xu L., Zhang Y., Qian J., Cai M., Xin Y., Gao J., Xu K., Boerma J.T., Barber S.L. Trends in access to health services and financial protection in China between 2003 and 2011: A cross-sectional study. Lancet. 2012;379:805–814. doi: 10.1016/S0140-6736(12)60278-5. - DOI - PubMed

Publication types