Health Insurance Strategies to Improve Health Equity Among Patients With Rare Diseases in China: A Microsimulation-Based Study
Author(s)
Xuanqi Qiao, BS1, Yusheng Jia, MS2, Hainan Li, MS1, MIN HU, PhD1.
1Department of Health Economics, School of Public Health, Fudan University, Shanghai, China, 2Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
1Department of Health Economics, School of Public Health, Fudan University, Shanghai, China, 2Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVES: Despite expansions in orphan drug coverage within China's basic medical insurance system, significant health equity gaps persist. Taking multiple sclerosis (MS) as an example, this study compares projected health equity outcomes and budget impact of current health insurance schemes versus two enhanced alternatives: (1) universal subsidies providing equal financial support for medication, and (2) targeted subsidies offering greater support to lower-income patients.
METHODS: A national online survey conducted in July 2022 among MS patients collected data on demographics, baseline utilization of disease-modifying therapies (DMTs), and related costs. Logistic regression quantified relationships between annual out-of-pocket (OOP) DMT costs and utilization, informing policy-specific projections. A microsimulation model using a synthetic cohort of 50,000 forecasted quality-adjusted life years (QALYs) and costs over a 50-year horizon. Robustness was evaluated through one-way sensitivity analyses, and equity were assessed using generalized concentration indices (GCI).
RESULTS: Among 658 MS patients (mean age: 34.2 years; 68.5% female), baseline DMT utilization was 61.9%, showing pro-rich inequity (GCI=0.010; 95% CI: 0.008-0.013). Each 1,000 RMB reduction in annual OOP costs increased DMT use by 0.437% (P=0.032). Predicted DMT utilization was highest under the targeted policy (75.5%), slightly surpassing the universal policy (75.4%), and substantially exceeding current coverage (71.0%). Simulated QALYs averaged 6.34 (targeted), 6.33 (universal), and 6.22 (current). QALY distribution remained pro-rich under current (GCI=0.048; 95% CI: 0.025-0.070) and universal policies (GCI=0.045; 95% CI: 0.022-0.068) but equitable under targeted policy (GCI=-0.004; 95% CI: -0.027-0.019). Annual budget estimates for China’s MS population were 852 million RMB (current), 979 million RMB (universal), and 972 million RMB (targeted), all demonstrating fiscal sustainability.
CONCLUSIONS: Significant health inequities exist among MS patients under current health insurance schemes. Targeted subsidies improve equity without compromising health outcomes or fiscal sustainability. Incorporating socioeconomic factors into health insurance scheme design may substantially mitigate health inequity among rare disease populations.
METHODS: A national online survey conducted in July 2022 among MS patients collected data on demographics, baseline utilization of disease-modifying therapies (DMTs), and related costs. Logistic regression quantified relationships between annual out-of-pocket (OOP) DMT costs and utilization, informing policy-specific projections. A microsimulation model using a synthetic cohort of 50,000 forecasted quality-adjusted life years (QALYs) and costs over a 50-year horizon. Robustness was evaluated through one-way sensitivity analyses, and equity were assessed using generalized concentration indices (GCI).
RESULTS: Among 658 MS patients (mean age: 34.2 years; 68.5% female), baseline DMT utilization was 61.9%, showing pro-rich inequity (GCI=0.010; 95% CI: 0.008-0.013). Each 1,000 RMB reduction in annual OOP costs increased DMT use by 0.437% (P=0.032). Predicted DMT utilization was highest under the targeted policy (75.5%), slightly surpassing the universal policy (75.4%), and substantially exceeding current coverage (71.0%). Simulated QALYs averaged 6.34 (targeted), 6.33 (universal), and 6.22 (current). QALY distribution remained pro-rich under current (GCI=0.048; 95% CI: 0.025-0.070) and universal policies (GCI=0.045; 95% CI: 0.022-0.068) but equitable under targeted policy (GCI=-0.004; 95% CI: -0.027-0.019). Annual budget estimates for China’s MS population were 852 million RMB (current), 979 million RMB (universal), and 972 million RMB (targeted), all demonstrating fiscal sustainability.
CONCLUSIONS: Significant health inequities exist among MS patients under current health insurance schemes. Targeted subsidies improve equity without compromising health outcomes or fiscal sustainability. Incorporating socioeconomic factors into health insurance scheme design may substantially mitigate health inequity among rare disease populations.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD267
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Rare & Orphan Diseases