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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (6): 609-615.doi: 10.3969/j.issn.1000-6621.2018.06.012

• 论著 • 上一篇    下一篇

新疆五县(区)肺结核患者医疗费用及经济负担现况的调查分析

杜世昌,徐彩红,王丽,张慧(),陈伟()   

  1. 102206 北京,中国疾病预防控制中心结核病预防控制中心(杜世昌,在读研究生),政策规划部(徐彩红),主任办公室(张慧),监测部(陈伟);北京协和医学院基础学院流行病与统计教研室(王丽)
  • 收稿日期:2018-04-25 出版日期:2018-06-20 发布日期:2018-07-24
  • 基金资助:
    “十三五”国家科技重大专项(2017ZX10201302-007)

Investigation and analysis on the medical expenses and economic burden of pulmonary tuberculosis patients in five counties in Xinjiang

Shi-chang DU,Cai-hong XU,Li WANG,Hui ZHANG(),Wei. CHEN()   

  1. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  • Received:2018-04-25 Online:2018-06-20 Published:2018-07-24

摘要: 目的

了解新疆5个县(区)肺结核患者的医疗费用和家庭经济负担情况。

方法

采用多阶段分层整群抽样抽取2016年12月至2017年6月在新疆维吾尔自治区的哈密市伊州区、克孜勒苏柯尔克孜自治州阿图什市、乌鲁木齐市高新区、伊犁哈萨克自治州伊宁县、喀什地区泽普县结核病定点医院在治的251例肺结核患者,通过面对面问卷调查和导出医院电子病历数据库中数据,收集患者的社会经济情况及医疗费用信息,共发出251份问卷,收回有效问卷251份,对患者的社会人口学特征、各类费用及灾难性支出发生率进行描述性分析。

结果

5个县(区)患者自付总费用的中位数(四分位数)为3949.4(1648.6,10721.9)元,直接医疗费用为1416.4(440.0,5063.3)元,直接非医疗费用为640.6(358.2,1336.0)元,间接费用为495.7(81.4,2696.2)元。5个县(区)患者的直接医疗费用占自付总费用的46.3%(4298.5/9291.7),间接费用占37.2%(1539.3/9291.7)。5个县(区)患者灾难性支出发生率达到59.8%(150/251),伊州区、阿图什市、高新区、伊宁县和泽普县的灾难性支出发生率分别为60.8%(31/51)、74.0%(37/50)、56.0%(28/50)、50.0%(25/50)、58.0%(29/50),差异无统计学意义(χ 2=6.58,P=0.160);有住院史患者、无住院史患者灾难性支出发生率分别为80.6%(29/36)、56.3%(121/215),差异有统计学意义(χ 2=7.56,P=0.006);工人、职员及农牧民患者的灾难性支出发生率为66.7%(102/153),家务、待业、离退休及学生患者的灾难性支出发生率为49.0%(48/98),差异有统计学意义(χ 2=7.77,P=0.005);文盲或半文盲患者、非文盲患者的灾难性支出发生率分别为77.5%(31/40)、56.4%(119/211),差异有统计学意义(χ 2=6.23,P=0.013)。

结论

5个县(区)肺结核患者的直接医疗费和间接费用较高,将造成患者发生家庭灾难性支出。

关键词: 结核, 肺, 费用, 医疗, 患病代价, 小地区分析

Abstract: Objective

To understand the medical expenses and family economic burden of the patients with pulmonary tuberculosis in 5 counties of Xinjiang.

Methods

From Dec. 2016 to June 2017, relying on the “Baseline survey on household catastrophic health expenditure due to TB in China”, a multi stage stratified cluster sampling was used to extract 251 tuberculosis patients at the designated hospital of tuberculosis from Yizhou District, Artux city, High-tech Zone, Yining County, Zapp County in Xinjiang Uygur Autonomous Region. Through face-to-face questionnaire survey and export of data from the hospital electronic medical records database, the social classics of patients were collected. A total of 251 questionnaires were sent out and 251 valid questionnaires were collected. Descriptive analysis was made on the demographic characteristics, expenses and disastrous expenses of the patients.

Results

The median (quartile(Q1, Q3)) of the total cost of patients in five counties was 3949.4 (1648.6,10721.9), the direct medical cost was 1416.4 (440.0,5063.3) yuan, the direct non-medical cost was 640.6 (358.2,1336.0) yuan, and the indirect cost was 495.7 (81.4,2696.2) yuan. The direct medical expenses of the patients in the five counties accounted for 46.3% (4298.5/9291.7) of the total cost of self-payment, and the indirect cost accounted for 37.2% (1539.3/9291.7) of the total cost of self-payment. The proportion of catastrophic expenditure in five counties was 59.8% (150/251). The proportion of catastrophic expenditure in Yizhou, ITU, Hi-tech, Yining and Zip counties were 60.8% (31/51), 74.0% (37/50), 56.0% (28/50), 50.0% (25/50), 58.0% (29/50), respectively. and there was no significant difference between five counties (χ 2=6.58,P=0.16). The proportion of catastrophic expenditure was 80.6% (29/36) and 56.3% (121/215) in patients with hospitalized history and no hospitalization history, respectively. The proportion of catastrophic expenditure in the two groups was significantly different (χ 2=7.56,P=0.006). The rate of catastrophic expenditure for workers and farmers and herdsmen was 66.7% (102/153), and the proportion of catastrophic expenditure for household chores, retirees and students was 49.0% (48/98), and the proportion of catastrophic expenditure in these two types of patients was significantly different (χ 2=7.77, P=0.005). The proportion of catastrophic expenditure for illiterate or semi illiterate patients and non-illiterate patients was 77.5% (31/40) and 56.4% (119/211) respectively. The difference in the proportion of catastrophic expenditure in the two types of patients was significant (χ 2=6.23, P=0.013).

Conclusion

The direct medical and indirect costs of tuberculosis patients in the five counties are high, resulting in TB patients (and their households) catastrophic expenditure.

Key words: Tuberculosis, pulmonary, Fees, medical, Cost of illness, Small-area analysis