Analysis of economic burden of pulmonary tuberculosis patients in four districts and counties of Chongqing

doi:10.19982/j.issn.1000-6621.20210633

Abstract

Abstract:

Objective: To investigate the economic burden of pulmonary tuberculosis patients in less developed districts and counties of Chongqing, and to provide data support for optimizing the medical insurance policy for tuberculosis patients. Methods: A cross-sectional study was conducted in 326 active pulmonary tuberculosis patients registered in Qianjiang district, Fengdu county, Kaizhou district and Wushan county of Chongqing from June 2019 to June 2020. The expenses and personal burden of patients due to illness were analyzed through questionnaire survey and diagnosis and treatment information and medical expenses collected from hospital information system. Results: Of the 326 cases, the average course of treatment was 180.0 (178.0,210.0) days, the direct medical cost before and after diagnosis were RMB 1600.0 (920.0,3500.0) yuan and RMB 2479.0 (1218.9,5709.6) yuan, respectively. Direct non-medical expenses after illness were RMB 1300.0 (400.0,3000.0) yuan, the indirect lost because of tuberculosis treatment was RMB 3850.0 (500.0,15000.0) yuan, and the total medical cost was RMB 14156.8 (6904.7,28133.9) yuan; 80.98% (264/326) of patients had family catastrophic expenditure for the treatment of pulmonary tuberculosis. Conclusion: The economic burden of tuberculosis patients in less developed areas of Chongqing is heavy. The current medical insurance reimbursement policy can not completely alleviate the economic burden of patients. The reimbursement policy for tuberculosis medical insurance in Chongqing should be further improved, and the disastrous expenses should be reduced.

Key words: Tuberculosis,pulmonary, Fees,medical, Poverty areas, Medical indigency, Small-area analysis

CLC Number:

R521

WU Bo, LIU Ying, LIAO Wen-pin, ZHENG Yi, QIN Bo, YANG Jing, XIE Hui-man, YU Ya. Analysis of economic burden of pulmonary tuberculosis patients in four districts and counties of Chongqing[J]. Chinese Journal of Antituberculosis, 2022, 44(4): 390-396. doi: 10.19982/j.issn.1000-6621.20210633

Figures/Tables 4

References 22

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人口学特征	例数	构成比(%)
性别
男性	214	65.64
女性	112	34.36
民族
汉族	257	78.83
少数民族	69	21.17
职业
农民	206	63.19
公职人员	7	2.15
学生	51	15.64
家务及待业	38	11.66
其他^a	24	7.36
文化程度
小学及以下	179	54.91
初中	75	23.01
高中及以上	72	22.08
婚姻状况
未婚	82	25.15
已婚	212	65.03
离异/丧偶	32	9.82
医疗保险类型
城镇职工保险	19	5.83
城乡居民保险	305	93.56
商业保险	2	0.61
诊断结果
病原学阳性	190	58.28
病原学阴性	127	38.96
无病原学结果	9	2.76
治疗史
初治	302	92.64
复治	24	7.36

类别	丰都县	巫山县	开州区	黔江区	合计
治疗时间[d,M(Q₁,Q₃)]	190.0 (182.0,213.7)	208.0 (187.5,279.0)	182.5 (181.0,184.0)	183.0 (173.0,197.5)	180.0 (178.0,210.0)
平均门诊次数[M(Q₁,Q₃)]	6.0 (5.0,7.8)	7.0 (4.0,9.0)	7.0 (6.0,9.0)	6.0 (5.0,6.0)	6.0 (5.0,8.0)
平均住院天数[M(Q₁,Q₃)]	7.0 (4.0,10.0)	8.0 (5.5,10.0)	-	7.0 (5.0,8.0)	7.0 (5.0,9.0)
门诊医疗费用[元,M(Q₁,Q₃)]	1204.3 (889.9,1749.5)	1573.6 (1026.9,2285.9)	5288.9 (2545.7,7458.7)	1151.3 (735.2,1515.2)	1387.8 (971.4,2393.8)
住院医疗费用[元,M(Q₁,Q₃)]	5523.6 (2803.1,8569.1)	5758.0 (4285.9,7246.8)	-	4198.0 (3356.2,5540.2)	4639.6 (3395.0,6238.5)
次均门诊医疗费用[元,M(Q₁,Q₃)]	211.6 (146.2,271.7)	241.0 (175.7,318.4)	682.3 (493.0,863.2)	195.4 (140.1,263.5)	247.5 (167.0,388.7)
日均住院医疗费用[元,M(Q₁,Q₃)]	856.9 (670.3,945.5)	720.3 (612.2,835.4)	-	661.2 (553.2,936.1)	724.9 (586.3,952.6)
直接医疗费用[元,M(Q₁,Q₃)]	3646.2 (2412.7,5890.2)	4215.9 (3069.2,7605.0)	7767.3 (5236.1,11338.9)	6644.1 (4212.9,9900.8)	5524.8 (3194.2,8722.9)
间接费用[元,M(Q₁,Q₃)]	0.0 (0.0,2750.0)	10000.0 (0.0,21500.0)	10000.0 (2850.0,20000.0)	3000.0 (0.0,11460.0)	3850.0 (500.0,15000.0)
直接非医疗费用[元,M(Q₁,Q₃)]	500.0 (282.5,857.5)	2150.0 (1025.0,3575.0)	2050.0 (425.0,5275.0)	1500.0 (600.0,2750.0)	1300.0 (400.0,3000.0)
治疗总费用[元,M(Q₁,Q₃)]	5664.2 (3647.8,11426.0)	17481.8 (9588.9,36830.1)	22381.0 (14875.0,36997.1)	16115.2 (8161.5,27558.5)	14156.8 (6904.7,28133.9)

医疗保险类型	住院情况	纳入调查的患者例数	获得报销的患者例数	直接医疗费用 [元,M(Q₁,Q₃)]	报销费用 [元,M(Q₁,Q₃)]	报销后自付费用 [元,M(Q₁,Q₃)]	费用报销比例 (%)^a
城镇职工医疗保险	仅门诊	12	12	1984.2 (639.8,5723.9)	286.1 (60.1,1239.7)	1539.6 (761.5,3921.5)	14.42
	门诊和住院	7	7	8234.1 (4129.3,11234.2)	2119.1 (862.1,5293.2)	5993.9 (2394.7,8342.6)	25.74
城乡居民医疗保险	仅门诊	216	168	1148.9 (521.7,5231.6)	139.2 (52.4,612.4)	987.6 (429.6,2835.1)	12.12
	门诊和住院	89	89	6832.9 (3201.0,11124.2)	1102.1 (521.6,3615.2)	5087.2 (1294.2,9341.4)	16.13
商业医疗保险	仅门诊	2	1	1734.2 (491.2,3579.4)	110.8 (51.2,612.8)	1605.2 (523.1,6521.4)	6.39
	门诊和住院	0	0	0	0	0	-
合计		326	277	5524.8 (3194.2,8722.9)	926.5 (164.6,1528.8)	4736.1 (2893.3,9429.9)	16.77

类别	丰都县	巫山县	开州区	黔江区	合计
获得报销的患者占比(%)	46.15 (36/78)	94.51 (86/91)	96.77 (60/62)	100.00 (95/95)	84.97 (277/326)
直接医疗费用[元,M(Q₁,Q₃)]	3646.2 (2412.7,5890.2)	4215.9 (3069.2,7605.0)	7767.3 (5236.1,11338.9)	6644.1 (4212.9,9900.8)	5524.8 (3194.2,8722.9)
医疗保险报销费用[元,M(Q₁,Q₃)]	251.4 (150.8,459.9)	645.1 (172.0,1493.9)	869.6 (311.3,1174.8)	1288.5 (471.7,2822.8)	926.5 (164.6,1528.8)
患者自付费用[元,M(Q₁,Q₃)]	3390.7 (1864.9,4893.2)	3640.8 (2539.6,7532.8)	6829.1 (3219.5,10234.2)	5248.6 (1396.2,7621.4)	4736.1 (2893.3,9429.9)