Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study
Abstract Background Disparities in the utilization, expenditures, and quality of care by insurance types have been well documented. Such comparisons have yet to be investigated in end-of-life (EOL) settings in China, where public insurance covers over 95% of the Chinese population. This study examin...
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-020-09463-1 |
| _version_ | 1818950774108979200 |
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| author | Zhong Li Peiyin Hung Ruibo He Xiaoming Tu Xiaoming Li Chengzhong Xu Fangfang Lu Pei Zhang Liang Zhang |
| author_facet | Zhong Li Peiyin Hung Ruibo He Xiaoming Tu Xiaoming Li Chengzhong Xu Fangfang Lu Pei Zhang Liang Zhang |
| author_sort | Zhong Li |
| collection | DOAJ |
| description | Abstract Background Disparities in the utilization, expenditures, and quality of care by insurance types have been well documented. Such comparisons have yet to be investigated in end-of-life (EOL) settings in China, where public insurance covers over 95% of the Chinese population. This study examined the associations between health insurance and EOL care in the last six months of life: outpatient visits, emergency department (ED) visits, inpatient services, intensive care unit (ICU) admissions, expenditures, and place of death among the cancer patients. Methods A total of 398 patients diagnosed with cancer who survived more than 6 months after diagnosis and died from July 2015 to June 2017 in urban Yichang, China, were included. Descriptive analysis and multivariate regression models were used to investigate the bivariate and independent associations, respectively, between health insurance with EOL healthcare utilization, expenditures and place of death. Results Urban Employee Basic Medical Insurance (UEBMI) beneficiaries visited EDs more frequently than Urban Resident-based Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS) beneficiaries (marginal effects [95% Confidence Interval]: 2.15 [1.81–2.48] and 1.92 [1.59–2.26], respectively). NRCMS and UEBMI beneficiaries had more hospitalizations than URBMI beneficiaries (1.01 [0.38–1.64] and 0.71 [0.20–1.22], respectively). Compared to URBMI beneficiaries, NRCMS beneficiaries and UEBMI beneficiaries had ¥15,722 and ¥43,241 higher expenditures. Similarly, UEBMI beneficiaries were most likely to die in hospitals, followed by NRCMS (UEBMI vs. NRCMS: 0.23 [0.11–0.36]) and URBMI (UEBMI vs. URBMI: 0.67 [0.57–0.78]) beneficiaries. Conclusions The disproportionately lower utilization of EOL care among NRCMS and URBMI beneficiaries, compared to UEBMI beneficiaries, raised concerns regarding quality of EOL care and financial burdens of NRCMS and URBMI beneficiaries. Purposive hospice care intervention might be warranted to address EOL care for these beneficiaries in China. |
| first_indexed | 2024-12-20T09:23:56Z |
| format | Article |
| id | doaj.art-08610fcc03f84313b4fde3ea0d039e20 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-20T09:23:56Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj.art-08610fcc03f84313b4fde3ea0d039e202022-12-21T19:45:14ZengBMCBMC Public Health1471-24582020-09-012011910.1186/s12889-020-09463-1Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective studyZhong Li0Peiyin Hung1Ruibo He2Xiaoming Tu3Xiaoming Li4Chengzhong Xu5Fangfang Lu6Pei Zhang7Liang Zhang8Department of Social Medicine and Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Health Services Policy and Management, Arnold School of Public Health, University of South CarolinaDepartment of Labor and Social Security, School of Finance and Public Administration, Hubei University of EconomicsDepartment of Intelligent Computing and Mathematics, School of Biomedical Engineering and Informatics, Nanjing Medical UniversityDepartment of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South CarolinaYichang Center for Disease Control and PreventionYichang Center for Disease Control and PreventionYichang Center for Disease Control and PreventionDepartment of Social Medicine and Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and TechnologyAbstract Background Disparities in the utilization, expenditures, and quality of care by insurance types have been well documented. Such comparisons have yet to be investigated in end-of-life (EOL) settings in China, where public insurance covers over 95% of the Chinese population. This study examined the associations between health insurance and EOL care in the last six months of life: outpatient visits, emergency department (ED) visits, inpatient services, intensive care unit (ICU) admissions, expenditures, and place of death among the cancer patients. Methods A total of 398 patients diagnosed with cancer who survived more than 6 months after diagnosis and died from July 2015 to June 2017 in urban Yichang, China, were included. Descriptive analysis and multivariate regression models were used to investigate the bivariate and independent associations, respectively, between health insurance with EOL healthcare utilization, expenditures and place of death. Results Urban Employee Basic Medical Insurance (UEBMI) beneficiaries visited EDs more frequently than Urban Resident-based Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS) beneficiaries (marginal effects [95% Confidence Interval]: 2.15 [1.81–2.48] and 1.92 [1.59–2.26], respectively). NRCMS and UEBMI beneficiaries had more hospitalizations than URBMI beneficiaries (1.01 [0.38–1.64] and 0.71 [0.20–1.22], respectively). Compared to URBMI beneficiaries, NRCMS beneficiaries and UEBMI beneficiaries had ¥15,722 and ¥43,241 higher expenditures. Similarly, UEBMI beneficiaries were most likely to die in hospitals, followed by NRCMS (UEBMI vs. NRCMS: 0.23 [0.11–0.36]) and URBMI (UEBMI vs. URBMI: 0.67 [0.57–0.78]) beneficiaries. Conclusions The disproportionately lower utilization of EOL care among NRCMS and URBMI beneficiaries, compared to UEBMI beneficiaries, raised concerns regarding quality of EOL care and financial burdens of NRCMS and URBMI beneficiaries. Purposive hospice care intervention might be warranted to address EOL care for these beneficiaries in China.http://link.springer.com/article/10.1186/s12889-020-09463-1End-of-life careExpendituresPlace of deathHealth insuranceCancer patients |
| spellingShingle | Zhong Li Peiyin Hung Ruibo He Xiaoming Tu Xiaoming Li Chengzhong Xu Fangfang Lu Pei Zhang Liang Zhang Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study BMC Public Health End-of-life care Expenditures Place of death Health insurance Cancer patients |
| title | Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study |
| title_full | Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study |
| title_fullStr | Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study |
| title_full_unstemmed | Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study |
| title_short | Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study |
| title_sort | disparities in end of life care expenditures and place of death by health insurance among cancer patients in china a population based retrospective study |
| topic | End-of-life care Expenditures Place of death Health insurance Cancer patients |
| url | http://link.springer.com/article/10.1186/s12889-020-09463-1 |
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