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International Journal of Clinical Oncology

Published in:

01-06-2016 | Original Article

Health insurance status and survival among patients with head and neck cancer in Japan

Authors: Yukinori Takenaka, Toshimichi Yasui, Keisuke Enomoto, Haruka Miyabe, Natsue Morizane, Naoki Ashida, Kotaro Shimizu, Masayuki Hirose, Yoshifumi Yamamoto, Atsuhiko Uno

Published in: International Journal of Clinical Oncology | Issue 3/2016

Abstract

Background

Healthcare systems vary among countries, and in many countries, insurance and economic statuses significantly impact the mortality associated with head and neck squamous cell carcinoma (HNSCC). Japan prides itself on its unique healthcare and health insurance system, which provides equal coverage and healthcare access with low individual payments to most citizens. Additionally, citizens in poverty are covered by insurance for the poor (public assistance) and receive medical and other types of assistance. Hence, they have no barriers to healthcare services. This study aimed to determine the impact of health insurance status on mortality in Japanese patients with HNSCC.

Methods

We reviewed 409 patients with HNSCC, using the Kaplan–Meier method to estimate overall survival. The association between insurance status and disease stage at diagnosis was analyzed via logistic regression. Cox and Fine–Gray proportional hazard models were employed to investigate the impact of insurance status on survival.

Results

The public assistance and other insurances groups did not significantly differ in clinical stage distribution. The 5-year overall survival, cumulative incidence of HNSCC death, and cumulative incidence of other death rates were 63.3 and 59.1 %, 27.0 and 31.8 %, and 10.3 and 9.7 % for the public assistance and other insurances groups, respectively. The adjusted subdistribution hazard ratio for the association between public assistance and HNSCC death was 0.73 (95 % confidence interval 0.44–1.21).

Conclusions

The demonstrated non-inferiority of public assistance regarding HNSCC-specific mortality indicates the equality of healthcare in Japan, irrespective of the insurance status, and the superiority of the Japanese healthcare system.

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Title: Health insurance status and survival among patients with head and neck cancer in Japan
Authors: Yukinori Takenaka
Toshimichi Yasui
Keisuke Enomoto
Haruka Miyabe
Natsue Morizane
Naoki Ashida
Kotaro Shimizu
Masayuki Hirose
Yoshifumi Yamamoto
Atsuhiko Uno
Publication date: 01-06-2016
Publisher: Springer Japan
Published in: International Journal of Clinical Oncology / Issue 3/2016
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-015-0921-5

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