Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study

Abstract

BackgroundCancer, the leading cause of mortality in China, is a significant burden on patients, their families, the medical system, and society at large. However, there is minimal data on health service utilization and catastrophic health expenditure (CHE) among cancer patients in China. The objective of this study was to identify factors associated with health care utilization and CHE in Chinese cancer patients.MethodsThe 2018 wave of a nationally representative dataset, the China Health and Retirement Longitudinal Study, was used in our study. Of 18,968 respondents recruited for the analysis, 388 were clinically diagnosed with cancer. CHE was defined as household health expenditure that exceeded 40% of non-food household expenses. A binary logistic regression model was used to identify the risks of cancer exposure among all participants, along with the likelihood of CHE in households with cancer patients at the 40% threshold. A negative binomial regression model was used to identify determinants of health service utilization among cancer patients.ResultsContracting a family physician (incidence rate ratio IRR: 2.38, 1.18–4.77), Urban Employee Basic Medical Insurance (IRR: 4.02, 1.91–8.46, compared to the uninsured), Urban and Rural Resident Basic Medical Insurance (IRR: 3.08, 1.46–6.49, compared to the uninsured), and higher per-capita household consumption were positively associated with inpatient service utilization. Patients with a college education and above reported a greater number of outpatient visits (IRR: 5.78, 2.56–13.02) but fewer inpatient hospital days (IRR: 0.37, 0.20–0.67). Being diagnosed with a non-cancer chronic non-communicable disease was associated with an increased number of outpatient visits (IRR: 1.20, 1.10–1.31). Of the 388 participants, 50.1% of households had CHE, which was negatively correlated with a larger household size (odds ratio OR: 0.52, 0.32–0.86) and lower socioeconomic status [for quintile 5 (lowest group) OR: 0.32, 0.14–0.72].ConclusionsThe socioeconomic characteristics of cancer patients had a considerable impact on their healthcare utilization. Individualized and targeted strategies for cancer management should be implemented to identify high-risk populations and trace the utilization of care among Chinese cancer patients. Strategic purchasing models in cancer care and social health insurance with expanded benefits packages for cancer patients are crucial to tackling the cancer burden in China.

Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011–2018 China Health and Retirement Longitudinal Study

“…Furthermore, this study showed that higher quintiles of per-capita household expenditure were significantly related to higher odds of outpatient service use and higher rates of inpatient service use, which consolidates the empirical evidence that health service use often favored the better-off [ 5 , 8 , 23 , 26 , 45 , 47 , 48 , 51 ]. The potential explanation could be that individuals in higher quintiles can better articulate their demands for regular health care [ 5 ].…”

“…In China, there are no gate-keeping general practitioner system and strict referral system [ 23 ], where primary health care is delivered by primary care facilities and hospitals for both emergency and non-emergency services [ 23 ]. However, few studies in China have examined the effect of SES on healthcare utilization using various indicators of SES such as wealth [ 5 , 45 ], income [ 6 , 46 – 48 ], health insurance [ 8 , 19 , 47 – 51 ], or education [ 23 , 26 , 47 , 52 ]. Nevertheless, it is evident that disparities in health service use in China are primarily determined by individual’s financial capacity [ 1 , 6 , 13 ].…”

“…Per-capita household expenditure is a better proxy for financial capacity in the context of China [ 3 , 11 , 52 , 53 ], but has less likely been used in the literature. Also, the relationship between SES and health service use is conflicting–some studies show a positive relationship [ 5 , 8 , 23 , 26 , 45 , 47 , 48 , 51 ], whereas others reveal no association [ 5 , 6 , 19 , 52 ]. Moreover, little is known about whether the impact of SES on health service use differs across morbidity status (i.e., no NCDs, a single NCD, and multimorbidity) [ 1 ].…”

“…It is thus expected that the prevalence of multiple NCDs may exaggerate the effect of SES on health service use [ 1 ]. Additionally, published studies in China were mostly based on cross-sectional study designs [ 1 – 5 , 7 , 9 , 13 – 15 , 19 , 20 , 23 , 29 , 45 , 47 – 49 , 51 ], while little evidence was from longitudinal studies [ 8 , 24 , 26 , 52 ]. Due to broader socioeconomic changes, population ageing, disease burden changes, and health service development [ 23 ], investigating the longitudinal changes in healthcare utilization is warranted.…”

Catastrophic health expenditure, incidence, trend and socioeconomic risk factors in China: A systematic review and meta-analysis

“…In 2020, China accounted for ~3 million of the estimated 9.96 million cancer deaths worldwide, accounting for 30.2% of cancer deaths worldwide. This has led to an increase in the cost of cancer treatment in China ( 32 , 33 ). Currently, China is reducing the OOP expenditure on cancer treatment by including more innovative cancer drugs in the National Catalog of Medical Insurance (NRLD) and using centralized procurement to reduce their prices.…”