Mukundan A, Nagisetti Y, Karmakar R, Wang HC. Insurance coverage and patient outcomes: Understanding changes in esophageal cancer treatment. World J Gastrointest Oncol 2025; 17(7): 107154 [DOI: 10.4251/wjgo.v17.i7.107154]
Corresponding Author of This Article
Hsiang Chen Wang, Department of Mechanical Engineering, National Chung Cheng University, No. 168 University Road, Min Hsiung, Chiayi 62102, Taiwan. hcwang@ccu.edu.tw
Research Domain of This Article
Oncology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jul 15, 2025; 17(7): 107154 Published online Jul 15, 2025. doi: 10.4251/wjgo.v17.i7.107154
Insurance coverage and patient outcomes: Understanding changes in esophageal cancer treatment
Arvind Mukundan, Yaswanth Nagisetti, Riya Karmakar, Hsiang Chen Wang
Arvind Mukundan, Department of Chemistry, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India
Arvind Mukundan, Riya Karmakar, Hsiang Chen Wang, Department of Mechanical Engineering, National Chung Cheng University, Chiayi 62102, Taiwan
Yaswanth Nagisetti, Department of Electronics and Communication Engineering, Vel Tech Rangarajan Dr. Sagunthala R&D Institute of Science and Technology, Chennai 600062, Tamil Nadu, India
Co-first authors: Arvind Mukundan and Yaswanth Nagisetti.
Co-corresponding authors: Riya Karmakar and Hsiang Chen Wang.
Author contributions: Mukundan A and Nagisetti Y made equal contributions as co-first authors. Mukundan A, Nagisetti Y, Karmakar R, and Wang HC contributed to conceptualization, review and editing; Mukundan A and Wang HC contributed to formal analysis and project administration; Karmakar R and Nagisetti Y contributed to investigation and software; Wang HC contributed to supervision; Nagisetti Y wrote the original draft. Karmakar R and Wang HC contributed equally to the manuscript as co-corresponding authors. All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hsiang Chen Wang, Department of Mechanical Engineering, National Chung Cheng University, No. 168 University Road, Min Hsiung, Chiayi 62102, Taiwan. hcwang@ccu.edu.tw
Received: March 17, 2025 Revised: April 18, 2025 Accepted: May 16, 2025 Published online: July 15, 2025 Processing time: 120 Days and 1 Hours
Abstract
The article by Wu et al highlights the growing incidence of esophageal tumor patients, particularly in China, where the high frequency and death rate are significant problems. The article also examined the impact of health insurance on treatment availability and patient outcomes, demonstrating that the type of insurance can affect the financial burden on patients. This study investigates the effects of different types of health care coverage, namely Urban Employee Basic Medical Insurance vs Urban-Rural Resident Basic Medical Insurance, and the personal spending ratio on treatment decisions and survival outcomes. The database used is derived from esophageal tumor patient continuation from Chongqing University Hospital in China. A total of 2543 patients were included in the study, allowing for the formation of research cohorts. Patient information included demographic characteristics. The study followed various processes to maintain consistency, including data sources, inclusion and exclusion criteria, follow-up duration, health insurance, and statistical analysis. The average age at diagnosis ranged from 57-74 years, and predominantly included men, married people, and those of Han ethnic background, comprising 2088 and 2519 individuals, respectively. Upon controlling for age, sex, relationship status, country of origin, pathological evaluation, tumor stage, and biochemical indicators, individuals who had Urban Employee Basic Medical Insurance exhibited a higher propensity to opt for radiotherapy, chemotherapy, immunotherapy, and targeted therapy compared to those covered by the Urban-Rural Resident Basic Medical Insurance. During the follow-up phase of the study, a total of 1438 deaths were documented, with 1106 ascribed to esophageal cancer. Additionally, individuals with Urban-Rural Resident Basic Medical Insurance had a significantly elevated risk of esophageal cancer, particularly mortality, compared to those without Urban-Rural Resident Basic Medical Insurance.
Core Tip: A recent study investigated how public health insurance differences between Urban Employee Basic Medical Insurance and Urban-Rural Resident Basic Medical Insurance together with out-of-pocket contribution levels affect treatment options and survival rates of Chinese patients with esophageal cancer. The study evaluated 2543 patients within the Chongqing University Cancer Hospital through the examination of how financial pressures affect treatment accessibility. Under Urban Employee Basic Medical Insurance public healthcare, patient mortality risk increased. However, patients exercising higher out-of-pocket payments demonstrated better survival results, presumably due to access to improved medical services. Access to high-quality medical care requires immediate reformation to eliminate inequities that disproportionately affect lower-income patients.
