Associations among healthcare insurance, tumor-node-metastasis stage and cancer survival: More to be understood.

Cancers remain a major health burden with a high mortality rate in China. Basic medical insurance, is the most important element in the financial support system of healthcare resources in both urban and rural areas, and requires further understanding to improve health policy. For instance, a single hospital-based prospective cohort study found that esophageal cancer survival outcomes were associated with different healthcare payment patterns and situations. Comparing the extracted literature-data between urban employee basic medical insurance and urban and rural resident basic medical insurance, the proportions of tumor-node-metastasis (TNM) stage I-II were 27.1% and 34.6%, while those of TNM stage IV were 35.0% and 26.1%, respectively. Additionally, high out-of-pocket rate (> 60%) of hospitalization was associated with a higher proportion of TNM stage I-II (40.3% vs 26.9%) and a lower proportion of TNM stage IV (22.7% vs 32.8%). In addition, healthcare payment simultaneously influenced or was influenced by the proportions of early and advanced esophageal cancers. The critical difficulty in improving survival of esophageal cancer in populations should be a low proportion of early disease. A more comprehensive and robust public healthcare insurance system is desired to support cancer prevention and control in particular, in order to increase the proportion of early cancers and consequently improve patient survival. Additionally, commercial medical insurance and social charities hope to be fully introduced and encouraged to achieve these goals as active supplement.