Liu Xiaoyun, Thomson Rachael, Gong Youlong, Zhao Fengzeng, Squire S Bertel, Tolhurst Rachel, Zhao Xinping, Yan Fei, Tang Shenglan
School of Public Health, Fudan University, Shanghai, China, and EQUI-TB Programme, Liverpool School of Tropical Medicine, Liverpool, UK.
Trop Med Int Health. 2007 Dec;12(12):1464-71. doi: 10.1111/j.1365-3156.2007.01953.x.
To assess equity in access to tuberculosis (TB) care by estimating and comparing the direct household costs perceived by community residents with actual costs experienced by TB patients and to identify the factors influencing the financial burden of TB patients.
Economic study in four provinces of China by means of a survey of 889 TB patients and 2560 community residents and in-depth interviews with key informants.
The direct household costs for using TB health services perceived by the communities were two to five times higher than the actual costs incurred by the TB patients. Patients had to pay a substantial proportion of their annual income for TB services (12-40%), despite the fact that smear-positive and some severe smear-negative patients received free drugs. Repeated outpatient visits before diagnosis, over-prescription of drugs and prolonged treatments were common.
The heavy financial burden (both perceived and real) on these patients is one of the main reasons that some TB patients fail to access and complete treatment. Pressure to generate revenue through current incentives in health-care financing and poor competence of health workers at the village and township levels cause delay and high expenses to TB patients and ultimately impede effective TB control in China.
通过估计和比较社区居民感知的结核病（TB）治疗直接家庭成本与结核病患者实际经历的成本，评估获得结核病治疗的公平性，并确定影响结核病患者经济负担的因素。
在中国四个省份进行经济研究，对889名结核病患者和2560名社区居民进行调查，并对关键信息提供者进行深入访谈。
社区感知的使用结核病医疗服务的直接家庭成本比结核病患者实际发生的成本高出两到五倍。尽管涂片阳性和一些严重涂片阴性患者可获得免费药物，但患者仍需支付其年收入的很大一部分用于结核病治疗（12% - 40%）。诊断前反复门诊、药物过度处方和治疗时间延长的情况很常见。
这些患者沉重的经济负担（包括感知到的和实际的）是一些结核病患者无法获得并完成治疗的主要原因之一。当前医疗保健筹资激励措施带来的创收压力以及乡镇卫生工作者能力不足，给结核病患者造成延误和高额费用，最终阻碍了中国结核病的有效控制。
