Insurance coverage and patient outcomes: Understanding changes in esophageal cancer treatment

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.

Key Words: Esophageal cancer; Public health; Insurance; Prognosis; Mortality risk

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.

INTRODUCTION

The Global Cancer Statistics reveals that esophageal cancer stands at position eight for new cases and sixth for deaths among all malignant tumors worldwide in 2020[1]. New esophageal cancer cases are approaching 320000, with approximately 300000 deaths. In the same year, China accounted for 53.70% of global esophageal cancer cases and 55.35% of related deaths. Esophageal cancer in China resulted in 5.76 million disability-adjusted life years in 2019, comprising 49.40% of the global burden for esophageal cancer. A total of 1.02 million person-years accrued in the 65 to 69 years age group, which represented the highest disability-adjusted life years. Early disease detection remains crucial because the age-specific pattern matches the global distribution data, making it important to establish screening programs and timely diagnosis procedures for treating younger individuals. The hospital-based multicenter retrospective survey reported that in 2011, patients with esophageal cancer treated at 37 hospitals across 13 Chinese provinces/municipalities incurred an average expenditure of 46124 Chinese yuan, excluding income loss due to illness[2]. New research demonstrates that esophageal cancer leads to major health challenges, placing considerable economic pressure on worldwide populations while putting further strain on developing countries such as China[3]. In this editorial, we provide an evaluation and critical analysis of Wu et al’s study, which utilized Chongqing University Cancer Hospital patient data from 2543 subjects analyzed through Cox regression models adjusted for demographic and clinical background[4].

The disease risk of the general population gets distributed through primary health care funding methods called public health insurance; however, its risk sharing capability depends on different combinations of patient factors and insurance types[5]. There is an urgent need exists study health care insurance system optimization methods for reducing esophageal cancer patient mortality while decreasing financial burden. Esophageal cancer research has primarily analyzed how medical coverage affects patient financial expenses[6]. The current literature lacks substantial evidence connecting medical insurance to diagnosis results[7]. The analysis investigates connections between mortality rate and insurance type among esophageal cancer patients in Chongqing China from July 2018 to December 2020[8].

The research study established major conclusions describing how public health insurance impacts patient death rates. Populations under Urban Employee Basic Medical Insurance presented a 23.30% increase in mortality rate from esophageal cancer compared to Urban-Rural Resident Basic Medical Insurance beneficiaries[9]. Furthermore, patients in high out-of-pocket ratio groups experienced a 25.80% reduction in esophageal cancer-specific mortality risks. The results indicate that higher out-of-pocket expenses allow patients access to better treatment options, leading to better survival outcomes. The study results contradict the common belief that expanded health insurance programs produce increased health benefits. Insurance type in combination with cost-sharing mechanisms shape treatment decisions that lead to variations in patient prognosis.

An 10% increase in out-of-pocket patient expenses led to a 10.10% decrease in esophageal cancer-related deaths among patients with Urban Employee Basic Medical Insurance, yet the death risk for high out-of-pocket patients rose by 26.90%. The data demonstrates that higher financial responsibility leads some patients to better treatments but excessive financial constraints impede others from getting the necessary healthcare. Higher out-of-pocket expenses among patients with Urban-Rural Resident Basic Medical Insurance led them to pick surgical interventions and targeted therapies, which have better survival probabilities.

This research detected distinct treatment practices between different patient groups. Patients with public insurance received more chemotherapy and immunotherapy treatments, while patients with high out-of-pocket expenses under Urban Resident Basic Health insurance plans opted for surgical treatment only. The overall differences in treatment choices show that insurance policies have significant effects on healthcare decisions and survival rates of patients in China[10]. Public insurance serves as an important factor that enables healthcare access but does not provide sufficient equality in treatment options across all patient populations[11].

CLINICAL IMPLICATIONS

The clinical outcomes from this study provide necessary guidance for treating patients with esophageal cancer. The key factor for improving survival outcomes is obtaining the best treatment option; therefore, insurance policy structures should protect patients from financial obstacles that restrict their access to effective therapies[12]. The analysis demonstrates that when patients must pay more, they select different treatments than those who have their care fully covered by insurance benefits. Patients who pay more of their healthcare expenses tend to select therapeutic options that lead to superior outcomes, including surgical procedures and immunotherapies as well as targeted therapies[13]. Healthcare providers must support government officials by promoting insurance policies that provide fully accessible top-level medical interventions. Healthcare providers should educate patients about all treatment options, then motivate them to seek care early since this approach delivers better results[14].

Patient care requires multiple professionals from oncology practices to work in partnership with insurance experts and financial counselors for developing personalized treatment plans. The combination of this approach allows patients to create treatment choices that consider both price and medical outcome effectiveness[15]. High-quality treatment accessibility must have financial incentive programs from health institutions that assist underprivileged patients to obtain needed medical care without high treatment costs. The combined strategy will lead to better health results while eliminating unequal esophageal cancer treatment.

SOCIOECONOMIC FACTORS

The level of health care access along with treatment results strongly depends on socioeconomic conditions. Studies have shown that healthcare service quality improves when patients pay more for their treatment[16]. The present situation generates concerns regarding equity in healthcare, as financially disadvantaged patients lack funds to get premium medical care. Public health insurance structure demands reform to enhance financial coverage for advanced therapies, especially among disadvantaged patients[17]. The government needs to extend insurance coverage and require reimbursement policies to include costly yet efficient treatment choices. The reduction of healthcare inequities and survival rates in patients with esophageal cancer depends on fixing socioeconomic disparities.

The economic pressure resulting from cancer care treatment surpasses traditional treatment expenses. Extended treatment periods cause numerous cancer patients to experience income deprivation, which intensifies their financial difficulties. Patients require patient-centered support systems that protect their employment status and provide rehabilitation services alongside psychological counseling to lessen the socioeconomic effects of cancer treatment[18]. Healthcare facilities can create more accessible treatment settings for patients by deploying these measures to support patients regardless of their financial standing.

CONCLUSION

The research conducted by Wu et al[4] presents necessary evidence that healthcare policymakers and healthcare providers need to improve insurance models and esophageal cancer treatment methods. The successful implementation of public health insurance requires structural adjustments to accommodate evolving cancer treatment approaches that aim to reduce mortality rates. The study demonstrates that patients who pay higher out-of-pocket amounts receive better access to care. This findings highlights issues related to medical accessibility among low-income populations. Scientific research must expand the current findings into additional geographical areas and accumulate complete patient information sets to confirm reported results. The study has limitations, primarily because the data was collected from one institution in Chongqing, which may not reflect nationwide trends. Future research should expand this study by incorporating data from multiple centers alongside use of national cancer registries to strengthen this study’s conclusions, hile extending patient follow-up to 3 or 5 years.

The priority of healthcare policymakers should include early screening strategies, investing in innovative therapies, and creating financial support mechanisms for broad patient access to high-quality esophageal cancer treatment. Cost-effective therapeutic research initiatives supported by policymakers will help minimize the difference between treatment expenses and treatment quality. The elimination of healthcare disparities will advance esophageal cancer patient outcomes throughout China as well as global settings by creating fair survival prospects and improved quality-of-life for every patient.