Comparison of out-of-pocket expenditure and catastrophic health expenditure for severe disease by the health security system: based on end-stage renal disease in South Korea

Catastrophic health expenditure associated with non-inpatient costs among middle-aged and older individuals in China

Background

Since their establishment, the two predominant social health insurance schemes in China, Urban Employee Medical Insurance (UEMIS) and Urban and Rural Residents' Medical Insurance (URRMS), have primarily focused on covering non-inpatient expenditure, while costs associated with outpatient care and pharmaceutical purchases have been largely excluded from the insurance benefit package. This study intends to analyze the distribution of non-hospitalization expenditure and assess resulting financial risks, with an objective to reform the health insurance benefit package by including coverage for non-hospitalization costs.

Methods

The primary data were obtained from the 2018 wave of CHARLS, encompassing a total of 12942 individuals for analysis. Assess the financial risk associated with non-hospitalization expenses through catastrophic health expenditures (CHE) and examine the determinants of CHE using logistic regression analysis.

Results

Over 60% of the participants availed non-inpatient services in the month preceding the investigation. A smaller proportion (14.26 and 14.28% for UEMIS and URRMS enrollee, respectively) utilized outpatient services provided by medical institutions, while a larger proportion (54.20 and 56.91% for UEMIS and URRMS enrollee, respectively) purchased medication from pharmacies. The study reveals a distinct subgroup of participants (8.91 and 6.82% for UEMIS and URRMS enrollee, respectively) who incurs substantial out-of-pocket non-inpatient expenditure, surpassing 1,000 RMB per month. However, reimbursement for non-inpatient expenditures is significantly limited under the two predominant health insurance schemes, and there is minimal disparity in the distribution of non-inpatient expenses before and after insurance reimbursement. The prevalence of CHE resulting from non-inpatient costs was substantial, particularly among participants enrolled in URRMS (25.06%) compared to those enrolled in UEMIS (14.26%). The presence of chronic diseases, advanced age, and limited financial resources are all determinants contributing to the occurrence of CHE.

Conclusion

The incorporation of non-inpatient expenses into China's fundamental health insurance plan remains a contentious issue, given the limited available evidence. This study presents empirical evidence underscoring the significance of non-inpatient expenditures as a determinant of financial risk, thereby emphasizing the imperative to adjust China's fundamental health insurance benefit package in order to address risks associated with non-inpatient costs, particularly among individuals with chronic illnesses and limited income.

'Learning and growing together': exploring consumer partnerships in a PhD, an ethnographic study

BACKGROUND

Consumer and community involvement (CCI) in health research is increasingly recognised as best practice and is closely linked with calls for epistemic justice and more transparent university collaborations with consumers. Given doctoral candidates play a key role in the future of co-production, examination of consumer partnerships in PhDs is important. This study aimed to describe and evaluate consumer partnerships in a PhD from the perspective of the consumer co-researchers, the PhD candidate, and the academic supervisors including optimal approaches, impacts, and benefits and challenges.

METHODS

This prospective, co-produced ethnographic study was conducted over 33 months. Data collection included field notes, a monthly online log of partnership experiences and time spent, interviews or a focus group every six months, and a PhD student reflexive diary. Qualitative data were analysed using reflexive thematic analysis.

RESULTS

The student, two academics, and four consumer co-researchers were involved. A mean of 11.10 h per month were spent on CCI. The student spent the most time (mean 15.86 h per month). Preparation for dissemination of findings was the most frequent partnership activity. The two overarching themes emphasised that a PhD promotes a rich partnership ethos with the student at the centre and that the partnership was a worthwhile but challenging process. The four sub-themes highlighted that developing a collegial and supportive environment with regular meetings combined with a multi-faceted and responsive co-learning approach were core to success. Additionally, there were benefits for individuals, research processes and outcomes, and for driving change in consumer-academic research partnerships. Recruiting to and forming the partnership, maintaining the collaboration through inevitable changes and challenges, and an ethical and supportive closure of the research team were critical.

CONCLUSIONS

This longitudinal ethnographic study demonstrated that doctoral research can create a rich ethos for research and knowledge co-production which evolved over time. Equalising power dynamics through relationship building and co-learning was critical. Additionally, a focus on supportively ending the partnership was essential, and CCI may reduce PhD student isolation and procrastination. Enhanced university incentivisation of co-production in health research is recommended to address gaps in consumer remuneration and student support.

Real world evidence study on treatment patterns and health resource utilization in patients with HR+/HER2- locally advanced or metastatic breast cancer in Korea

Objective

To understand current treatment patterns and health care resource utilization (HRU) of women with locally advanced or metastatic breast cancer (advanced breast cancer; ABC) in Korea overall and within patients who had progressed with prior endocrine therapy (as first-line treatment for metastatic disease) and patients with no prior systemic treatment (for advanced disease).

Methods

A chart review was conducted in 109 patients (women ≥ 18 years old with HR+/HER2- ABC diagnosed between 2015 and 2017) from 11 hospitals. Anonymized data on patient characteristics, treatment patterns and HRU was abstracted.

Results

Mean (range) age of all patients was 57.5 (40–81) years. Overall, the most common first-, second- and third-line systemic therapy after diagnosis of ABC were letrozole ± palbociclib (51%), endocrine therapy (ET)±everolimus (42%) or chemotherapy (ChT) (39%), and ChT (68%), respectively. In patients progressed with ET (n = 33) and those with no prior systemic treatment (n = 52), the most common first-line treatments were letrozole (82%) and letrozole + palbociclib (42%), respectively. The percentage of patients with at least one grade 3 or higher adverse event during first-line therapy was 93.1% vs 39.2% in patients on a ChT based regimen (N = 29) vs. ET (N = 74). Overall, oncologist visits, at an annual rate of 9.27 (95% CI: 8.87, 9.69) visits per month, and hospitalizations, with an annual rate of 0.44 (95% CI: 0.36, 0.54), and mean (SD) length of stay of 14.3 (10.32) days, were the key drivers of HRU.

Conclusions

These findings on real world HRU reflected clinical guidelines and severity of ABC. Results can inform future evaluations of new ABC treatments that estimate the health economic impact of their adoption in Korea.