Catastrophic and Socioeconomic Disparities Across Different Payment Schemes in Lung Cancer Treatment: A Cross-Sectional Single-Centre Analysis from Thailand

Abstract

Objective: To identify the magnitude of catastrophic health expenditure (CHE) and medical impoverishment across three payment schemes and compare the within-scheme financial disparity. Material and Methods: A cross-sectional analysis of CHE and medical impoverishment among lung cancer patients was conducted at a university hospital in Thailand. A total of 367 lung cancer patients drawn from three payment schemes were included. The clinical data were collected from the hospital’s Electronic Medical Records, while the socioeconomic data, including cost details, were collected via an interview-based questionnaire from November 2020 to June 2022. Economic analyses were performed using concentration curves and logistic regression modeling. Results: There were 38%, 21% and 27% impoverished patients belonging to the Universal Coverage Scheme (UCS), Social Security Scheme (SSS) and Civil Servant Medical Benefit Scheme (CSMBS), respectively, and approximately further 30% in each scheme became impoverished owing to medical-related expenses. Socioeconomic disparities in CHE; concentration index; CI=-0.36 UCS, -0.59 CSMBS and -0.47 UCS, and medical impoverishment; CI=0.16 UCS, -0.15 CSMBS and 0.10 UCS, were evident in all schemes. These inequities were more pronounced among CSMBS patients. Moreover, if not impoverished already, the probability of medical impoverishment in all payment schemes peaked in the middle quintile and declined thereafter. Conclusion: Across all payment schemes, CHE and medical impoverishment occurred at rates of around 60% and 30%, respectively, among lung cancer patients in Thailand. The gradient of CHE probability was more prominent among CSMBS patients.

Keywords

• non-small cell lung cancer
• catastrophic health expenditure
• disparity