Outpatient reimbursement policies for cancer treatment in China: a comparative and longitudinal analysis

Cancer poses a huge health and economic burden globally, with China being no exception. While China’s basic medical insurance (BMI) program has expanded outpatient coverage for chronic diseases, including cancer, there is a lack of national-level guiding policies. This study aims to investigate disparities and inequities in outpatient cancer reimbursement across China by analyzing reimbursement policies in different cities and under different medical insurance schemes. We conducted a cross-sectional analysis of outpatient reimbursement policies for cancers in China in 2022, supplemented by a longitudinal policy analysis. Data were collected from 85 prefecture-level cities under two insurance schemes: The Urban Employee Basic Medical Insurance (UEBMI) and the Urban and Rural Resident Basic Medical Insurance (URRBMI). We analyzed three key indicators: deductible threshold, reimbursement ratio, and reimbursement cap, using descriptive statistics to assess disparities and correlate them with local GDP per capita. Significant differences were observed in reimbursement caps and ratios between the two medical insurance schemes (P < 0.005 and P < 0.001, respectively). Only the reimbursement cap was positively correlated with GDP per capita under both schemes (rs = 0.27, P = 0.01 for UEBMI; rs = 0.36, P = 0.001 for URRBMI). Longitudinally, sample cities showed unchanged or lower deductible thresholds, while reimbursement ratios and caps either remained unchanged or increased. National guidelines for outpatient cancer reimbursement are needed in China to facilitate local policy refinement and enhance outpatient reimbursement level, thereby promoting healthcare accessibility and equity.