Li ZY, Wang R, Chen XZ, SIGES Research Group. Associations among healthcare insurance, tumor-node-metastasis stage and cancer survival: More to be understood. World J Gastrointest Oncol 2025; 17(9): 106116 [DOI: 10.4251/wjgo.v17.i9.106116]
Corresponding Author of This Article
Xin-Zu Chen, MD, PhD, Professor, Gastric Cancer Center & Gastric Cancer Laboratory, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China. chenxinzu@scu.edu.cn
Research Domain of This Article
Health Policy & Services
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. Sep 15, 2025; 17(9): 106116 Published online Sep 15, 2025. doi: 10.4251/wjgo.v17.i9.106116
Associations among healthcare insurance, tumor-node-metastasis stage and cancer survival: More to be understood
Zhuo-Yu Li, Rui Wang, Xin-Zu Chen, SIGES Research Group
Zhuo-Yu Li, Xin-Zu Chen, Gastric Cancer Center & Gastric Cancer Laboratory, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Rui Wang, Department of Gastroenterology, Nursing Section, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Xin-Zu Chen, Ya’an Cancer Prevention and Control Center, Ya’an People’s Hospital - West China Ya’an Hospital, Sichuan University, Ya'an 625000, Sichuan Province, China
Xin-Zu Chen, Ya’an Key Laboratory for High Altitude Medicine, Ya’an People’s Hospital - West China Ya’an Hospital, Sichuan University, Ya'an 625000, Sichuan Province, China
SIGES Research Group, Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Co-corresponding authors: Rui Wang and Xin-Zu Chen.
Author contributions: Li ZY for the literature searching and writing; Wang R for the conception, literature review and academic support; Chen XZ for the conception, interpretation, writing, and academic inspection; Both Chen XZ and Wang R have played important and indispensable roles in the conception, secondary review of literature data, interpretation and manuscript preparation as the co-corresponding authors.
Supported by the Foundation of Science and Technology Department of Sichuan Province, China, No. 23ZDYF0839; Ya'an Science and Technology Plan of Economic and Social Development (Health Field), Ya’an, China, No. 2024-1; and the Ya’an Philosophic and Social Science Research Plan, Ya’an, China, No. YAA20240035.
Conflict-of-interest statement: All 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: Xin-Zu Chen, MD, PhD, Professor, Gastric Cancer Center & Gastric Cancer Laboratory, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China. chenxinzu@scu.edu.cn
Received: February 17, 2025 Revised: May 26, 2025 Accepted: August 4, 2025 Published online: September 15, 2025 Processing time: 210 Days and 23.3 Hours
Abstract
Cancers remain a major health burden with a high mortality rate in China. Basic medical insurance, is the most important element in the financial support system of healthcare resources in both urban and rural areas, and requires further understanding to improve health policy. For instance, a single hospital-based prospective cohort study found that esophageal cancer survival outcomes were associated with different healthcare payment patterns and situations. Comparing the extracted literature-data between urban employee basic medical insurance and urban and rural resident basic medical insurance, the proportions of tumor-node-metastasis (TNM) stage I-II were 27.1% and 34.6%, while those of TNM stage IV were 35.0% and 26.1%, respectively. Additionally, high out-of-pocket rate (> 60%) of hospitalization was associated with a higher proportion of TNM stage I-II (40.3% vs 26.9%) and a lower proportion of TNM stage IV (22.7% vs 32.8%). In addition, healthcare payment simultaneously influenced or was influenced by the proportions of early and advanced esophageal cancers. The critical difficulty in improving survival of esophageal cancer in populations should be a low proportion of early disease. A more comprehensive and robust public healthcare insurance system is desired to support cancer prevention and control in particular, in order to increase the proportion of early cancers and consequently improve patient survival. Additionally, commercial medical insurance and social charities hope to be fully introduced and encouraged to achieve these goals as active supplement.
Core Tip: Basic medical insurance patterns, out-of-pocket (OOP) payment rates, and incremental willing-to-pay were found to be associated with esophageal cancer survival through the confounder, the proportion of tumor-node-metastasis stages in a hospital-based cohort. Inpatient’s data showed that subsets of urban employee basic medical insurance or low OOP rate had greater proportion of advanced cancer, mainly due to more reimbursable healthcare provision. Future real-world studies based on the regional population might be more informative to understand the impact and improvement of basic medical insurance policy in China. More comprehensive and robust public healthcare insurance system is desired to support cancer prevention and control in particular, for the sake of increasing the proportion of early cancers and consequently improving their population survival.
