Molecular Parasitology Laboratory, Division of Infectious Diseases, Queensland Institute of Medical Research, Brisbane, Australia.
PLoS Negl Trop Dis. 2013 Aug 1;7(8):e2350. doi: 10.1371/journal.pntd.0002350. Print 2013.
Access to health care is a major requirement in improving health and fostering socioeconomic development. In the People's Republic of China (P.R. China), considerable changes have occurred in the social, economic, and health systems with a shift from a centrally planned to a socialist market economy. This brought about great benefits and new challenges, particularly for vertical disease control programs, including schistosomiasis. We explored systemic barriers in access to equitable and effective control of schistosomiasis.
Between August 2002 and February 2003, 66 interviews with staff from anti-schistosomiasis control stations and six focus group discussions with health personnel were conducted in the Dongting Lake area, Hunan Province. Additionally, 79 patients with advanced schistosomiasis japonica were interviewed. The health access livelihood framework was utilized to examine availability, accessibility, affordability, adequacy, and acceptability of schistosomiasis-related health care.
We found sufficient availability of infrastructure and human resources at most control stations. Many patients with advanced schistosomiasis resided in non-endemic or moderately endemic areas, however, with poor accessibility to disease-specific knowledge and specialized health services. Moreover, none of the patients interviewed had any form of health insurance, resulting in high out-of-pocket expenditure or unaffordable care. Reports on the adequacy and acceptability of care were mixed.
CONCLUSIONS/SIGNIFICANCE: There is a need to strengthen health awareness and schistosomiasis surveillance in post-transmission control settings, as well as to reduce diagnostic and treatment costs. Further studies are needed to gain a multi-layered, in-depth understanding of remaining barriers, so that the ultimate goal of schistosomiasis elimination in P.R. China can be reached.
获得医疗保健是改善健康和促进社会经济发展的主要要求。在中国，社会、经济和卫生系统发生了重大变化，从中央计划经济向社会主义市场经济转变。这带来了巨大的利益和新的挑战，特别是对垂直疾病控制项目，包括血吸虫病。我们探讨了获得公平和有效控制血吸虫病的系统障碍。
2002 年 8 月至 2003 年 2 月，在湖南省洞庭湖地区对 66 名血吸虫病防治站工作人员进行了访谈，并与 6 名卫生人员进行了焦点小组讨论。此外，还对 79 名晚期日本血吸虫病患者进行了访谈。利用卫生保健获取生计框架，检查与血吸虫病相关的卫生保健的可得性、可及性、可负担性、充足性和可接受性。
我们发现大多数防治站的基础设施和人力资源都很充足。然而，许多晚期血吸虫病患者居住在非流行区或中度流行区，对特定疾病知识和专门卫生服务的可及性较差。此外，接受访谈的患者均未参加任何形式的医疗保险，导致自费支出较高或无法负担医疗费用。关于护理的充足性和可接受性的报告参差不齐。
结论/意义：需要加强血吸虫病传播控制后环境中的卫生意识和血吸虫病监测，同时降低诊断和治疗成本。需要进一步研究，以更深入地了解仍然存在的障碍，从而实现中国消除血吸虫病的最终目标。
