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- Original Article Differences in the public medical insurance systems for inflammatory bowel disease treatment in Asian countries
- Shu Chen Wei
-
Intestinal Research 2016;14(3):218-223.
DOI: https://doi.org/10.5217/ir.2016.14.3.218
Published online: June 27, 2016
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- Correspondence to Shu Chen Wei. Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, No.7 Chung-Shan South Road, Taipei 101, Taiwan. Tel: +886-2-23123456 ext. 65768, Fax: +886-2-23947927, shuchenwei@ntu.edu.tw
• Received: April 4, 2016 • Revised: April 8, 2016 • Accepted: April 8, 2016
© Copyright 2016. Korean Association for the Study of Intestinal Diseases. All rights reserved.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
-
Background/Aims
- The cost of caring for patients with inflammatory bowel disease (IBD) is high. Without government support, the cost burden will unavoidably rest on the patients and their family. However, the government providing full support will place a large financial burden on the health-care systems of a country. The aim of this study is to understand the current status of public medical insurance systems in caring for IBD patients among Asian countries.
-
Methods
- Questionnaires inquiring about the availability of public health systems; medical, diagnostic, and endoscopy costs; and coverage rate of biologics use were designed and sent to IBD experts in each of the Asian countries studied. The results were summarized according to the feedback from the responders.
-
Results
- The public health insurance coverage rate is high in Taiwan, Japan, South Korea, China, Hong Kong, and Singapore; but low in Malaysia and India. This probably affected the use of expensive medications mostly, such as biologics, as we found that the percentage of Crohn's disease (CD) treated with biologics were as high as 30%–40% in Japan, where the government covers all expenses for IBD patients. In India, the percentage maybe as low as 1% for CD patients, most of whom need to pay for the biologics themselves.
-
Conclusions
- There were differences in the public health insurance systems among the Asian countries studied. This reportprovidesthe background information to understand the differences in the treatment of IBD patients among Asian countries.
INTRODUCTION
METHODS
RESULTS
DISCUSSION
Acknowledgments
ACKNOWLEDGEMENT
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- 7. Asgharpour A, Cheng J, Bickston SJ. Adalimumab treatment in Crohn's disease: an overview of long-term efficacy and safety in light of the EXTEND trial. Clin Exp Gastroenterol 2013;6:153–160.PMID: 24039442.PubMedPMC
- 8. Wei SC, Lin MH, Tung CC, et al. A nationwide populationbased study of the inflammatory bowel diseases between 1998 and 2008 in Taiwan. BMC Gastroenterol 2013;13:166PMID: 10.1186/1471-230X-13-166. PMID: 24314308.ArticlePubMedPMC
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REFERENCES
Table 1
![ir-14-218-i001.jpg]()
General Information of the Public Health Insurance in Asia
Table 2
![ir-14-218-i002.jpg]()
Comparison of the Cost for IBD Diagnostic Tools in Asia
Table 3
![ir-14-218-i003.jpg]()
Comparison of the Cost for IBD Treatment in Asia
Table 4
![ir-14-218-i004.jpg]()
Comparison of the Cost for IBD Monitoring Tools in Asia
Table 5
![ir-14-218-i005.jpg]()
Comparison of the Cost for IBD Risk Management in Asia
Table 6
![ir-14-218-i006.jpg]()
Possible Impacts Derived From the Differences of Public Health Insurance in Asia
Figure & Data
REFERENCES
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Differences in the public medical insurance systems for inflammatory bowel disease treatment in Asian countries
General Information of the Public Health Insurance in Asia
| Variable | Taiwan | Japan | South Korea | China | Hong Kong | Singapore | Malaysia | India |
|---|---|---|---|---|---|---|---|---|
| Public health insurance cover rate | 99% | >90% | 100% | >95% | 92% | 100% | <5% | <5% |
| Access to GI/CRS specialist | Walk in/Refer | Walk in/Refer | Walk in/Refer | Walk in/Refer | Walk in/Refer | Walk in/Refer | Walk in/Refer | Walk in/Refer |
| General cost for IBD patients | Registered cases In patients: free (except some medications/examinations) | Registered cases: free | Registered cases: 10% | Free | Registered cases In patients: free (except some medications/examinations) | Co-pay: 10%–90% | Minimal pay (except expensive drugs) | Government hospital: free Private: have to pay |
| Registered cases Out patients: free | Registered cases Out patients: free (except some medications/examinations) | |||||||
| Non-registered cases: pay 5%–10% | Non-registered cases: pay 30% | Non-registered cases: pay 5%–10% |
GI/CRS, gastroenterology/colorectal surgeon.
Comparison of the Cost for IBD Diagnostic Tools in Asia
| Diagnosis (in US dollars) | Taiwan | Japan | South Korea | China | Hong Kong | Singapore | Malaysia | India |
|---|---|---|---|---|---|---|---|---|
| EGD | Free | Free | 10% of US dollars 50/30 | Free | Free | 300 | Free to minimal charge | 50 |
| Colonoscopy | Free | Free | 10% of US dollars 80/50 | Free | Free | 750 | Free to minimal charge | 100 |
| Small bowel scopet | Free except the over tube | Free | 700–1,200 | Co-pay | Free except the over tube | Free to minimal charge | 100 | |
| Over tube | 630–1,200 | Free | 600 | 130 | 400 | 1,000–2,500 | Free to minimal charge | 200 |
| Anesthesia | 100–500 | Free | Free | Free | Free | extra | Free to minimal charge | Extra |
| Capsule endoscopy | 1,500 | Free | 700 | 565 | 2,000 | 1,800 (public); 2,800 (private) | 1000 | 500 |
| CT/MRI | Free | Free | 10% of 160 (CT)/600 (MRI) | Free | Free | 500–1,000 | Free to minimal charge | 200 |
EGD, esophagogastroduodenoscopy
Comparison of the Cost for IBD Treatment in Asia
| Treatment (annual cost: US dollars) | Taiwan | Japan | South Korea | China | Hong Kong | Singapore | Malaysia | India |
|---|---|---|---|---|---|---|---|---|
| Non-biologics | ||||||||
| 5-ASA | Free | Free | 10% co-pay | Free | Free | 600–1,200 | 1,000–1,500, free for civil servants | 50 |
| Steroid | Free | Free | 10% co-pay | Free | Free | 300–600 | Free for civil servants, minimal charge for paying patients | 10 |
| Azathioprine | Free | Free | 10% co-pay | Free | Free | 600–1,200 | 300 USD for paying patients, free for civil servants | 50 |
| Biologics | ||||||||
| TNF-α antibody | Approved: free Not approved: 17,000 | Free | 10% co-pay | 15,000 | Approved: free Not approved: 15,000 | 25,000 | 20,000 for paying patients, pay and claim back for civil servants | 20,000–22,000 |
5-ASA, 5-aminosalicylic acid; TNF, tumor necrosis factor.
Comparison of the Cost for IBD Monitoring Tools in Asia
| Monitoring | Taiwan | Japan | South Korea | China | Hong Kong | Singapore | Malaysia | India |
|---|---|---|---|---|---|---|---|---|
| CBC/CRP/ESR/Biochemistry | Free | Free | 10% of 35/15 | Free | Free | 40–80 | Free | 20 |
| Fecal calprotectin | Research only | Research only | Research only | NA | NA | 40–80 | Research only | 60 |
| TNF-α Ab titer; Ab to TNF-Ab | NA | NA | NA | NA | NA | NA | NA | NA |
CBC, complete blood cell count; NA, not available; TNF, tumor necrosis factor.
Comparison of the Cost for IBD Risk Management in Asia
| Risk management (cost: US dollars) | Taiwan | Japan | South Korea | China | Hong Kong | Singapore | Malaysia | India |
|---|---|---|---|---|---|---|---|---|
| Hepatitis B screen | Free | Free | 100% co-pay | Free | Free | 10–20 | Free | 25 |
| TB Quantiferon Gold/Tuberculin skin test | Bundled to TNF-α Ab treatment | Free | 10% of 15 | 3 (PPD) | If research free/260 | 50–100 | 100 | 60 |
| TPMT genotype/Activity metabolites assay | NA | NA | NA | NA | NA | NA | NA | 100 |
| Vaccination (for example, Influenza) | Free to registered cases | 30 | 15; 100% co-pay | Free | Free | 20 | 20 | 75 |
TB, tuberculosis; TNF, tumor necrosis factor; PPD, purified protein derivative; TPMT, Thiopurine S-methyltransferase; NA, not available.
Possible Impacts Derived From the Differences of Public Health Insurance in Asia
| Possible impact | Taiwan | Japan | South Korea | China | Hong Kong | Singapore | Malaysia | India |
|---|---|---|---|---|---|---|---|---|
| % of CD patients treated with biologics | 25–30 | 30–40 | 20 | <10 | 15.4 | 10–15 | 25–30 | 1 (5%–10% indicated but only 1% affordable) |
| % of UC patients treated with biologics | Not approved by NHI yet (<1, paid by patients) | 10 | 2.2 | <5 | 1.4 | 5 | 5–10 | Even less |
| Mortality rate of IBD patients | Higher than Western Countries/ Japan | Similar to Western countries | No data | No data | No data | No data | No data | No data |
| SMR: 4.97 (3.72–6.63) for CD; 1.78 (1.46–2.17) for UC, from 1998 to 2008 in Taiwan8 | SMR: 1.43 (0.53–3.12) for CD9 |
NHI, national health insurance; SMR, standardized mortality ratio.
Table 1 General Information of the Public Health Insurance in Asia
GI/CRS, gastroenterology/colorectal surgeon.
Table 2 Comparison of the Cost for IBD Diagnostic Tools in Asia
EGD, esophagogastroduodenoscopy
Table 3 Comparison of the Cost for IBD Treatment in Asia
5-ASA, 5-aminosalicylic acid; TNF, tumor necrosis factor.
Table 4 Comparison of the Cost for IBD Monitoring Tools in Asia
CBC, complete blood cell count; NA, not available; TNF, tumor necrosis factor.
Table 5 Comparison of the Cost for IBD Risk Management in Asia
TB, tuberculosis; TNF, tumor necrosis factor; PPD, purified protein derivative; TPMT, Thiopurine S-methyltransferase; NA, not available.
Table 6 Possible Impacts Derived From the Differences of Public Health Insurance in Asia
NHI, national health insurance; SMR, standardized mortality ratio.
