Abstract: Objective  To understand the direct medical expense for diagnosis and treatment of pulmonary tuberculosis (PTB) patients and its financial burden on family in Shanghai, and to provide evidence for improving TB derating policy.   Methods  Seven districts in Shanghai were selected, and 491 pulmonary TB patients who had completed treatment were investigated by questionnaire. Information about the social economic conditions and direct medical expenses was collected. Ranksum test was used for analysis of patients’ social economic conditions and medical expenses.   Results  The medians (inter-quartile range) of TB patients’ total direct medical expenses and the derating proportion were 4000 (2500, 10 500) yuan/person and 54.9% (32.3%,70.0%) respectively. 34.4% of patients (169/491) had been hospitalized. There was significant difference between total direct medical expenses of outpatients and oncehospitalized patients (Z=-16.059,  P=0.000), the medians (inter-quartile range) of which were 3000(2000, 4000) yuan/person and 14 955(9200, 21 705) yuan/person respectively. The derating proportion of the total direct medical expenses in smear-positive patients was higher than that in smear-negative patients (Z=-2.092, P =0.036), the medians (inter-quartile range) of which were 57.1% (40.0%,71.5%) and 52.1%(25.0%,69.2%) respectively. There was significant difference between the ratio of out of pocket medical fee to family net per-capita income in outpatients and once-hospitalized patients（Z=-7.463, P=0.000）, the medians (inter-quartile range) of which were 9.4%(3.8%,18.0%) and 29.5%(14.8%,89.2%) respectively.   Conclusion  The diagnosis and treatment expenses of TB patients in Shanghai were relatively high, which resulted in a heavier financial burden to the patient’s family.

Key words: Pulmonary tuberculosis/economics, Fees,medical, Cost of illness, Shanghai City