Out-of-pocket expenses for people in China who have myasthenia gravis increased from 2013 to 2015, suggesting that current policies for medical insurance in China are inadequate for those living with the disease, a new study has found.
The study, “Out-of-pocket expenses for myasthenia gravis patients in China: a study on patients insured by basic medical insurance in China, 2013–2015,” was published in the Orphanet Journal of Rare Diseases.
Patients with myasthenia gravis (MG) typically require long-term treatment to keep their symptoms under control. These treatments can be expensive, and economic barriers can block access to patients’ much-needed medications. Paying for such treatments can have detrimental financial consequences and push patients into poverty.
In the study, researchers examined MG-associated costs for people in China covered by the Urban Basic Medicine Insurance (UBMI), a public health insurance program that provides medical insurance to people living in urban areas in China.
The UBMI is composed of the Urban Employee Basic Medical Insurance (UEBMI) and the Urban Resident Basic Medical Insurance (URBMI), which provide medical insurance to employees and residents, respectively.
Researchers analyzed the medical costs of 3,341 people with MG from 2013 to 2015. More than half (58.4%) of the patients were women, and nearly half (43.3%) were 50–69 years. Almost all (92.2%) were insured by UEBMI.
Over the course of the study period, the proportion of costs reimbursed by the insurance program gradually decreased from 73.1% to 58.7%. Correspondingly, total out-of-pocket expenses increased in the same period of time from 27.3% to 41.3%.
“Expenses reimbursed by BMI [basic medicine insurance] and patients’ OOP [out-of-pocket] expenses — both outpatient and inpatient—showed a similar trend,” investigators wrote.
Additional analyses were performed to assess the relative burden of out-of-pocket expenses based on several factors. These analyses revealed that individuals insured by URBMI were more likely to have greater out-of-pocket expenses compared to those insured by UEBMI.
Age and geographic region also were important factors, with greater expenses generally incurred by people who were older and living in less economically developed regions (e.g., western China, as compared to eastern China).
In addition, the types of hospitals individuals received treatment at also played an important role.
“The Chinese government has adopted a differential reimbursement policy among hospitals with different grades to prevent patients from overusing hospitals with superior resources,” researchers wrote.
In practice, this means less reimbursement for higher-grade specialty centers that include tertiary hospitals. However, as noted by researchers, people with rare diseases like MG may need to use these institutions more than the general public, specifically because they have a condition that requires expertise and specialized treatment.
“Hence, this model seems unfair to patients with MG,” they wrote. “Current Chinese medical insurance policy is designed to provide healthcare for the general public, and cannot meet the healthcare needs of MG patients. Therefore, it is crucial to formulate special insurance policies for patients with rare diseases such as MG to improve their medical security,” they wrote.
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