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A study in China shows that enhanced access to health insurance may help close an urban–rural gap in cancer treatment.

A new Chinese retrospective study published in the journal Risk Management and Healthcare Policy explored how better insurance coverage may enhance access to novel cancer therapies, like targeted anti-cancer drugs. Enhanced insurance coverage may also help reduce the urbanrural gap and, thus, health disparities. 

In China, non-Hodgkin lymphoma (NHL) is among the top 10 cancer types, affecting more than half a million individuals annually and causing more than a quarter of a million deaths. Thus, the burden is considerable. Rituximab, a monoclonal antibody against the B-lymphocyte antigen CD20 and the first to be approved for the treatment of CD20-positive NHL, is associated with improved patient outcomes.

Health Insurance Helps Reduce Urban–Rural Gap

Although therapies like rituximab have been game-changing in NHL treatment, these novel therapies are expensive. Therefore, they can significantly escalate healthcare costs for non-insured patients, further increasing health disparities and urban–rural healthcare gaps, as people living in rural areas often have a lower socioeconomic status. 

To overcome these disparities, China introduced a series of policies, including the National Reimbursement Drug List (NRDL) in 2009, to improve the accessibility and affordability of drugs for patients. Additionally, in 2017, China introduced a national health insurance coverage (NHIC) reform, which further helped enhance access to novel drug therapies like rituximab. Under the NHIC scheme, 80% of some drug costs are reimbursed. Additionally, the introduction of NHIC also saw a significant decline in the price of rituximab, making it easier for patients to access these medications.

In this new study, researchers collected data on cancer patients from two cancer treatment centers, focusing on data from September 2015 to August 2019, since they wanted to see the influence of NHIC on cancer treatment outcomes. The study included 1445 CD20-positive NHL patients from Fujian Cancer Hospital and Jiangsu Cancer Hospital. The data showed that since the introduction of NHIC, there has been a significant increase in the use of rituximab, from 64.79% to 74.88%. Interestingly, the study did not find any statistically significant difference in the use of rituximab in urban and rural regions. 

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The Bottom Line

The study confirms that making novel therapies more accessible and enhancing insurance coverage may help patients access novel therapies like rituximab for NHL. It may also help reduce the urban–rural gap. However, researchers state that some of their findings should be interpreted cautiously. The study found an insignificant urban–rural gap, since it was done in eastern coastal provinces with excellent transport and more developed infrastructure in rural areas. Therefore, it must be kept in mind that those dwelling in rural areas face many challenges, like inconvenient transportation, inferior medical services, and lower incomes. The financial burden of cancer treatment is much higher for those living in rural areas. Nonetheless, this study shows that policy changes can make reducing the urban–rural divide possible.


Lin-Lin, S., Lin, Y., Fang, W., Liu, Y., Bao, Y., Li, X., & Zhang, Y. (2023). How national health insurance coverage policy affected the use of trastuzumab and rituximab in China: a bicentric retrospective study. Risk Management and Healthcare Policy, Volume 16, 1739–1753. https://doi.org/10.2147/rmhp.s420899