Impacts of National Medical Insurance Negotiation on Antitumor Drug Utilization and Financial Burden: A City-Level Analysis in China
Author(s)
Zixuan Lyu, Master of Public Health1, Ni Yuan, PhD2, Anli Leng, PhD3, Shaonan Kong, PhD4, Jian Wang, PhD1.
1Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China, 2School of Public Health, Dalian Medical University, Dalian, China, 3School of Political Science and Public Administration, Shandong University, Qingdao, China, 4Chinese Journal of Digital Medicine Co., Ltd., Beijing, China.
1Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China, 2School of Public Health, Dalian Medical University, Dalian, China, 3School of Political Science and Public Administration, Shandong University, Qingdao, China, 4Chinese Journal of Digital Medicine Co., Ltd., Beijing, China.
OBJECTIVES: To assess changes in utilization, cost, and financial burden of anti-tumor drugs after national medical insurance negotiations and to evaluate their impact on patient access and affordability in a city in China.
METHODS: We analyzed 21,241 medical insurance settlement records from 2,925 oncology patients between 2018 and 2021. Descriptive statistics were used to assess medication utilization, cost patterns, daily cost limits, and catastrophic health expenditures (CHE). Nonparametric tests evaluated cost differences across patient characteristics.
RESULTS: Of the 2,925 patients, 62.5% were female and 50.8% were covered by urban and rural resident medical insurance. The majority (91.8%) received care at tertiary hospitals, and 83.0% were treated with outpatient special medications. Annual utilization of the 11 anti-tumor drugs increased by an average of 27.3%, with usage frequency rising by 42.7%. Meanwhile, daily cost limits decreased by 10.0% per year. In 2018-2019, over 40% of rural patients experienced CHE due to these drugs, though the incidence and intensity decreased by 2021. Significant differences in costs were observed across age, gender, insurance type, hospital level, and formulation (p < 0.05), with female patients and those receiving injections at tertiary hospitals incurring the highest costs.
CONCLUSIONS: The findings demonstrate improved access and insurance coverage for anti-tumor medications following national negotiations, as evidenced by increased utilization and decreased daily cost limits and CHE. However, rural patients continue to bear a disproportionate financial burden. Further policies and enforcement measures are needed to reduce inequities and improve affordability.
METHODS: We analyzed 21,241 medical insurance settlement records from 2,925 oncology patients between 2018 and 2021. Descriptive statistics were used to assess medication utilization, cost patterns, daily cost limits, and catastrophic health expenditures (CHE). Nonparametric tests evaluated cost differences across patient characteristics.
RESULTS: Of the 2,925 patients, 62.5% were female and 50.8% were covered by urban and rural resident medical insurance. The majority (91.8%) received care at tertiary hospitals, and 83.0% were treated with outpatient special medications. Annual utilization of the 11 anti-tumor drugs increased by an average of 27.3%, with usage frequency rising by 42.7%. Meanwhile, daily cost limits decreased by 10.0% per year. In 2018-2019, over 40% of rural patients experienced CHE due to these drugs, though the incidence and intensity decreased by 2021. Significant differences in costs were observed across age, gender, insurance type, hospital level, and formulation (p < 0.05), with female patients and those receiving injections at tertiary hospitals incurring the highest costs.
CONCLUSIONS: The findings demonstrate improved access and insurance coverage for anti-tumor medications following national negotiations, as evidenced by increased utilization and decreased daily cost limits and CHE. However, rural patients continue to bear a disproportionate financial burden. Further policies and enforcement measures are needed to reduce inequities and improve affordability.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE545
Topic
Economic Evaluation, Epidemiology & Public Health, Health Service Delivery & Process of Care
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology