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

Sep 4, 2026

Objective: quantify catastrophic health expenditure (CHE) magnitude and medical impoverishment across three lung cancer payment schemes and assess within-scheme financial disparity. Methods: cross-sectional analysis of CHE and medical impoverishment among 367 lung cancer patients at a Thai university hospital using electronic medical records for clinical data and interview-based questionnaires (Nov 2020–Jun 2022) for socioeconomic variables. Concentration curves and logistic regression modeled economic outcomes. Results: substantial impoverishment occurred across UCS, SSS, and CSMBS with pronounced disparities, especially for CSMBS.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages14

Reading Time35 min

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Introduction

Payment schemes in Thailand

Objective

Material and Methods

Study design and data sources

Economic analysis

Results

Conclusion

Catastrophic and Socioeconomic Disparities Across Different Payment Schemes in Lung Cancer Treatment: A Cross-Sectional Single-Centre Analysis from Thailand Sarayut L. Geater, M. D.1 , Paramee Thongsuksai, M. D.2 1Unit of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. 2Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. Received 22 July 2022 l Revised 19 October 2022 l Accepted 22 October 2022 l Published online 9 January 2023 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. This paper was from the 1st Annual Health Research International Conference (AHR-iCON, August 1-2, 2022). Contact: Paramee Thongsuksai, M.D. Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. E-mail: [paramee.t@psu.ac.th](paramee.t@psu.ac.th) © 2023 JHSMR. Hosted by Prince of Songkla University. All rights reserved. This is an open access article under the CC BY-NC-ND license ([http://www.jhsmr.org/index.php/jhsmr/about/editorialPolicies\#openAccessPolicy](http://www.jhsmr.org/index.php/jhsmr/about/editorialPolicies#openAccessPolicy)). J Health Sci Med Res 2023;41(3):e2023921 doi: 10.31584/jhsmr.2023921 [www.jhsmr.org](www.jhsmr.org) Catastrophic and Socioeconomic Disparities in Lung Cancer Geater SL and Thongsuksai P. 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 Introduction Cancers cause significant health burdens, and lung cancer ranks as one of the leading causes of health burden in males and one of the top five cancers in females worldwide. Lung cancer-related deaths account for one-fifth of total cancer-related deaths and bring a huge financial burden to patients and their families, the healthcare system, and society. These financial toxicities are not only due to direct medication/non-medication costs but also from indirect costs1. Cancer treatment costs can result in household impoverishment or catastrophic health expenditure (CHE) despite wide coverage of social health insurance, especially among patients who are elderly, with low education, living in a rural area and with low household income2,3 . Sun et al

FAQs

What was the study objective regarding lung cancer payment schemes?

The study quantified the magnitude of catastrophic health expenditure and medical impoverishment across three payment schemes and compared within-scheme financial disparity.

How were CHE and medical impoverishment analyzed in the study?

Economic analyses used concentration curves and logistic regression modeling based on clinical data from electronic medical records and socioeconomic data from interview-based questionnaires.

Which payment scheme showed more pronounced socioeconomic inequities?

Inequities were more pronounced among patients in the Civil Servant Medical Benefit Scheme (CSMBS).

Sep 4, 2026

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