Disparities in Lung Cancer Care Under Tiered Social Health Insurance in China

Strategic Insights -

Researchers from Peking University have revealed significant disparities in lung cancer care under tiered social health insurance (SHI) in China. A population-based study of 319,677 patients diagnosed with lung cancer between 2017 and 2021 in Shandong, China, found that those under the Urban Employee Basic Medical Insurance (UEBMI) scheme had better access to inpatient treatment and lower out-of-pocket expenditures compared to those under the Urban and Rural Resident Basic Medical Insurance (URRBMI) scheme. The study highlights the need for targeted harmonization of benefit packages to address pressing disparities in cancer care in low- and middle-income countries with tiered SHI.

Key Takeaways:

  • The study identified significant disparities in inpatient treatment and financial protection for lung cancer patients under tiered SHI in China.
  • Patients under UEBMI had a higher probability of receiving surgery for non-metastatic cancer, and higher probabilities of receiving radiotherapy or chemotherapy, targeted therapy, and immunotherapy for metastatic cancer.
  • UEBMI beneficiaries had 13.3% higher total expenditures but 19.1% lower out-of-pocket expenditures compared to those under URRBMI.
  • Higher proportions of inpatient cancer care utilization were seen in those under UEBMI compared to those under URRBMI, consistently with statistical significance.
  • Patients under UEBMI were also less likely to be discharged against medical advice than those under URRBMI.
  • The study suggests that targeted harmonization of benefit packages is needed to address pressing disparities in cancer care in low- and middle-income countries with tiered SHI.
  • The research was supported by the National Natural Science Foundation of China and the Henan Science And Technology Major Program.

Statistics:

  • 319,677 patients diagnosed with lung cancer between 2017 and 2021 in Shandong, China.
  • 13.3% higher total expenditures under UEBMI compared to URRBMI.
  • 19.1% lower out-of-pocket expenditures under UEBMI compared to URRBMI.
  • 24.5% (13,473 out of 55,111) of patients with metastatic cancer received surgery under UEBMI.
  • 12.9% (12,111 out of 94,002) of patients without metastasis received surgery under UEBMI.
  • 1.3% (728 out of 55,111) of patients with metastatic cancer received targeted therapy under UEBMI.
  • 1.1% (1,007 out of 94,002) of patients without metastasis received targeted therapy under UEBMI.

Sources:

  • Disparities in inpatient treatment and expenditures among lung cancer patients under tiered social health insurance: a population-based study in China. International Journal for Equity in Health, 2025,24(1):1-13.
  • http://www.equityhealthj.com/
  • https://doi-org.sdpl.idm.oclc.org/10.1186/s12939-025-02533-z