文章摘要
刘艳,徐彩红,王振宇,王晓墨,王艳红,张慧,王丽.我国结核病定点医院肺结核患者家庭经济负担现况调查[J].中华流行病学杂志,2019,40(5):559-564
我国结核病定点医院肺结核患者家庭经济负担现况调查
A cross-sectional study on economic burden of pulmonary tuberculosis cases from designated tuberculosis hospital
投稿时间:2019-01-15  
DOI:10.3760/cma.j.issn.0254-6450.2019.05.013
中文关键词: 肺结核;费用;经济负担;定点医院
英文关键词: Tuberculosis;Expenditure;Economic burden;Designated hospital
基金项目:世界卫生组织(2017/689045-0);盖茨基金结核病防治项目(三期)
作者单位E-mail
刘艳 中国医学科学院基础医学研究所北京协和医学院基础学院流行病学和卫生统计学系, 北京 100005  
徐彩红 中国疾病预防控制中心结核病预防控制中心, 北京 102206  
王振宇 中国医学科学院基础医学研究所北京协和医学院基础学院流行病学和卫生统计学系, 北京 100005  
王晓墨 中国医学科学院基础医学研究所北京协和医学院基础学院流行病学和卫生统计学系, 北京 100005  
王艳红 中国医学科学院基础医学研究所北京协和医学院基础学院流行病学和卫生统计学系, 北京 100005  
张慧 中国疾病预防控制中心结核病预防控制中心, 北京 102206 zhanghui@chinacdc.cn 
王丽 中国医学科学院基础医学研究所北京协和医学院基础学院流行病学和卫生统计学系, 北京 100005 liwang@ibms.pumc.edu.cn 
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中文摘要:
      目的 了解我国结核病定点医院就诊的肺结核患者从症状开始至治疗结束全程自付费用及其对家庭造成的经济负担现状,探讨结核病对家庭经济负担的影响因素。方法 以我国东、西部结核病定点医院为抽样框,采用分层整群抽样,在我国东部和西部各抽取5家结核病定点医院,连续招募2017年4-6月期间在上述10家医院就诊的肺结核患者535例,采用问卷调查方式收集患者的社会人口学特征、诊断及治疗相关费用。结果 我国结核病定点医院肺结核患者诊疗全程的人均自付总费用为12 635.5元,其中直接医疗费用占65.3%。不同阶段费用分析显示,近50%的费用发生在定点医院治疗前;文化程度低、初治、初始痰涂片阴性患者发生在定点医院之前的费用所占的比例显著高于其他人群。结核病患者自付总费用占患病前家庭年总收入比(费用收入比)的中位数为22%(10%~57%)。以肺结核患者费用收入比四分位为因变量进行有序logistic回归分析发现,文化程度低、家庭年收入低以及住院、伴有其他慢性病肺结核患者自付总费用占家庭年收入比例高。结论 定点医院就诊患者全程自付费用仍然较高。建议加强结核病非定点医疗机构发现并及时转诊患者的能力建设;结合不同类型患者的实际情况,进一步优化减免政策。
英文摘要:
      Objective To understand the medical expenditure and related household economic burden of pulmonary tuberculosis (TB) patients receiving full course treatment in designated TB hospitals in China and identify the related factors. Method A cross-sectional study was conducted in 535 consecutive TB patients receiving TB treatment from April 2017 to June 2017 in 5 designated TB hospitals in eastern and western China selected through stratified cluster sampling. A questionnaire was used to collect the information about patients' social economic characteristics and TB diagnosis and treatment expenditure. Results The average total medical expenditure for TB treatment was 12 635.5 yuan (RMB), in which the direct medical expenditure accounted for 65.3% of the total. Nearly half of the total medical expenditure occurred in pre-treatment period. The expenditure in pre- treatment period was higher in the patients with low education level, newly treated patients, and initial sputum negative patients. The median (quartile) for the ratio of total medical expenditure to annual household income was 22%(10%-57%). Ordinal logistic regression analysis showed that low-level education background, lower household income, hospitalization and suffering from other chronic disease might increase the ratio of medical expenditure to annual household income. Conclusions Medical expenditure for full course TB treatment is still high in patients in designated TB hospitals. It is suggested to strengthen the capability building of timely found and referral of TB patients in non- designated hospitals and improve fee reduction and exemption policy for some patients.
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