关键词: 结核, 肺/ 经济学, 患病代价, 上海市

Abstract: Objective  To understand the medical care economic burden of non-resident new pulmonary tuberculosis (TB) patients and its influencing factors in Putuo district, Shanghai. Methods  A retrospective study was conducted in rural-to-urban migrant tuberculosis patients who were diagnosed in 2008 and completed the treatment at the time of investigation. Information on the situation of individuals and families living with TB and patients’ direct medical expenses for TB diagnosis and treatment were extracted from questionnaire investigation. Ninety-seven pieces of 105 pieces questionnaires were collected and were valid. Medical records and data of reports were reviewed to check the information about patients’ background, the items of diagnostic tests, medications, and related expenses. Data were analyzed by SPSS 15.0 to describe patients’ household income and expenses in 2008, medical cost for TB diagnosis and treatment and the proportion of treatment cost from annual household income, and the medical cost and the proportion among different patients were compared. 0.05 was set as the criteria for statistically significant difference.  Results  The average medical expenses of TB care was 5177 Yuan per capita, accounting for 16.29% of the annual household income; of which 2452 Yuan was direct medical expenses, accounting for 8.23% of the income. The average medical expenses of TB care of male and female patients were 3174 Yuan and 1840 Yuan, which accounted for 9.92% and 5.94% of the annual family income respectively. The differences of average cost (Z=－1.722，P=0.085) and the proportion (Z=－1.664，P=0.096) between male and female were not significant. The average costs of TB care of patients with primary school education and lower, junior middle school, senior middle school and/or technical secondary school, and junior college and above were 3634 Yuan, 3109 Yuan, 1997 Yuan and 1745 Yuan respectively, of which the difference was not significant (χ²=4.094，P=0.251), while the proportions of treatment cost from annual household income of patients with different education level were 10.50%, 9.92%, 9.61% and 3.79% respectively, which were significantly different (χ²=9.225，P=0.026). The average medical expenses of TB care of patients with medical insurance, without medical insurance and unaware of insurance situation were 2765 Yuan, 1943 Yuan and 6115 Yuan respectively, of which the difference were significant (χ²=8.218，P=0.016), while the proportions of treatment cost from annual household income of patients with different medical insurance were 8.22%, 7.61% and 17.60% respectively, without significant difference (χ²=3.777，P=0.151). The average costs of TB care of smear positive and negative patients were 2046 Yuan and 3078 Yuan, which accounted for 7.69% and 8.50% of the annual household income respectively. The differences of average cost (Z=－0.685，P=0.493) and the proportion (Z=－0.094，P=0.925) between the positive and negative cases were not significant. The average medical expenses of TB care of in-patients and out-patients were 21 001 Yuan and 1988 Yuan, with the proportions of 54.99% and 7.27% of the annual family income respectively. The difference of average cost (Z=－5.233，P<0.001) and the proportion (Z=－4.392，P<0.001) between these two types of patients were significant. Conclusion  The non-resident TB patients in Putuo district are the focus group for TB control and prevention. TB diagnosis and treatment brings heavy economic burden on non-resident TB patients. The patients having been hospitalized during treatment, with lower education and without medical insurance have higher economic burden than others. It is imperative to implement pro-poor support policies to reduce the economic burden for effective TB control.

Key words: Tuberculosis, pulmonary/economics, Cost of illness, Shanghai city