Impact of the National Health Insurance Coverage Policy on the Utilisation and Accessibility of Innovative Anti-cancer Medicines in China: An Interrupted Time-Series Study
- PMID: 34422752
- PMCID: PMC8377668
- DOI: 10.3389/fpubh.2021.714127
Impact of the National Health Insurance Coverage Policy on the Utilisation and Accessibility of Innovative Anti-cancer Medicines in China: An Interrupted Time-Series Study
Abstract
Objective: The study aimed to evaluate the impact of the National Health Insurance Coverage (NHIC) policy on the utilisation and accessibility of innovative anti-cancer medicines in Nanjing, China. Methods: We used the adjusted World Health Organisation and Health Action International methodology to calculate the price and availability of 15 innovative anti-cancer medicines included in the National Health Insurance drug list in 20 tertiary hospitals and six secondary hospitals in Nanjing before and after NHIC policy implementation. Interrupted time-series regression was used to analyse the changes in the utilisation of the study medicines. Results: The price reduction rates of innovative anti-cancer medicines ranged between 34 and 65%. The mean availability rate was 27.44% before policy implementation and increased to 47.33% after policy implementation. The utilisation of anti-cancer medicines suddenly increased with a slope of 33.19-2,628.39 when the policy was implemented. Moreover, the usage rate of bevacizumab, bortezomib, and apatinib significantly increased (p < 0.001, p = 0.009, and p < 0.001, respectively) after policy implementation. With regard to price reduction and medical insurance reimbursement, the medicines became more affordable after policy implementation (0.06-1.90 times the per capita annual disposable income for urban patients and 0.13-4.46 times the per capita annual disposable income for rural patients). Conclusion: The NHIC policy, which was released by the central government, effectively improved the utilisation and affordability of innovative anti-cancer medicines. However, the availability of innovative anti-cancer medicines in hospitals remained low and the utilisation of innovative anti-cancer medicines was affected by some factors, including the incidence of cancer, limitation of indications within the insurance program, and the rational use of innovative anti-cancer medicines. It is necessary to improve relevant supporting policies to promote the affordability of patients. The government should speed up the process of price negotiation to include more innovative anti-cancer medicines in the medical insurance coverage, consider including both medical examinations and adjuvant chemotherapy in the medical insurance, and increase investment in health care.
Keywords: affordability; innovative anti-cancer medicines; interrupted time series; national health insurance coverage; utilisation.
Copyright © 2021 Fang, Xu, Zhu, Dai, Shang and Li.
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Figures
Similar articles
-
Promoting Access to Innovative Anticancer Medicines: A Review of Drug Price and National Reimbursement Negotiation in China.Inquiry. 2023 Jan-Dec;60:469580231170729. doi: 10.1177/00469580231170729. Inquiry. 2023. PMID: 37171066 Free PMC article. Review.
-
Trends in accessibility of negotiated targeted anti-cancer medicines in Nanjing, China: An interrupted time series analysis.Front Public Health. 2022 Jul 22;10:942638. doi: 10.3389/fpubh.2022.942638. eCollection 2022. Front Public Health. 2022. PMID: 35937254 Free PMC article.
-
Policy Updates on Access to and Affordability of Innovative Medicines in China.Value Health Reg Issues. 2022 Jul;30:59-66. doi: 10.1016/j.vhri.2021.12.003. Epub 2022 Feb 27. Value Health Reg Issues. 2022. PMID: 35235902 Review.
-
How government insurance coverage changed the utilization and affordability of expensive targeted anti-cancer medicines in China: an interrupted time-series study.J Glob Health. 2019 Dec;9(2):020702. doi: 10.7189/jogh.09.020702. J Glob Health. 2019. PMID: 31673344 Free PMC article.
-
Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China.Int J Environ Res Public Health. 2019 Oct 3;16(19):3728. doi: 10.3390/ijerph16193728. Int J Environ Res Public Health. 2019. PMID: 31623326 Free PMC article.
Cited by
-
The usage and costs of national drug price-negotiated anticancer medicines in a first-tier city in Northeast China: a study based on health insurance data.BMC Public Health. 2024 May 14;24(1):1309. doi: 10.1186/s12889-024-18820-3. BMC Public Health. 2024. PMID: 38745323 Free PMC article.
-
Access to innovative anticancer medicines in China: a national survey on availability, price and affordability.BMJ Open. 2024 Apr 25;14(4):e077089. doi: 10.1136/bmjopen-2023-077089. BMJ Open. 2024. PMID: 38670605 Free PMC article.
-
Price negotiation and pricing of anticancer drugs in China: An observational study.PLoS Med. 2024 Jan 2;21(1):e1004332. doi: 10.1371/journal.pmed.1004332. eCollection 2024 Jan. PLoS Med. 2024. PMID: 38166148 Free PMC article.
-
How the National Health Insurance Coverage policy changed the use of lenvatinib for adult patients with advanced hepatocellular carcinoma: a retrospective cohort analysis with real world big data.Int J Equity Health. 2023 Dec 11;22(1):256. doi: 10.1186/s12939-023-02052-9. Int J Equity Health. 2023. PMID: 38082426 Free PMC article.
-
Cost Drivers and Financial Burden for Cancer-Affected Families in China: A Systematic Review.Curr Oncol. 2023 Aug 16;30(8):7654-7671. doi: 10.3390/curroncol30080555. Curr Oncol. 2023. PMID: 37623036 Free PMC article. Review.
References
-
- Chen ZN. The frontier and innovation of biomedicine in the new era. China Food & Drug Administration Magazine. (2019) 11:8–13. 10.3969/j.issn.1673-5390.2019.11 - DOI
-
- Zhou YP, Wang HG, Hu QH, Zhou RS, Cheng BS, Kang FH, et al. . Accessibility of high-cost anti-cancer medicines in China. Chinese J Evidence-Based Med. (2017) 17:862–8. 10.7507/1672-2531.201703028 - DOI
-
- THE STATA COUNCIL . Opinions of the State Council on implementing the Health China Action. (2019). Available online at: http://www.gov.cn/zhengce/content/2019-07/15/content_5409492.htm (accessed: December 24, 2020).
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources