School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
Institute of Development Studies, Brighton, UK.
Infect Dis Poverty. 2019 Aug 2;8(1):67. doi: 10.1186/s40249-019-0575-z.
Tuberculosis (TB) is still a major public health problem in China. To scale up TB control, an innovative programme entitled the 'China-Gates Foundation Collaboration on TB Control in China was initiated in 2009. During the second phase of the project, a policy of increased reimbursement rates under the New Cooperative Medical Scheme (NCMS) was implemented. In this paper, we aim to explore how this reform affects the financial burden on TB patients through comparison with baseline data.
In two cross-sectional surveys, quantitative data were collected before (January 2010 to December 2012) and after (April 2014 to June 2015) the intervention in the existing NCMS routine data system. Information on all 313 TB inpatients, among which 117 inpatients in the project was collected. Qualitative data collection included 11 focus group discussions. Three main indicators, non-reimbursable expenses rate (NER), effective reimbursement rate (ERR), and out-of-pocket payment (OOP) as a percentage of per capita household income, were used to measure the impact of intervention by comprising post-intervention data with baseline data. The quantitative data were analysed by descriptive analysis and non-parametric tests (Mann-Whitney U test) using SPSS 22.0, and qualitative data were subjected to thematic framework analysis using Nvivo10.
The nominal reimbursement rates for inpatient care were no less than 80% for services within the package. Total inpatient expenses greatly increased, with an average growth rate of 11.3%. For all TB inpatients, the ERR for inpatient care increased from 52 to 66%. Compared with inpatients outside the project, for inpatients covered by the new policy, the ERR was higher (78%), and OOP showed a sharper decline. In addition, their financial burden decreased significantly.
Although the nominal reimbursement rates for inpatient care of TB patients greatly increased under the new reimbursement policy, inpatient OOP expenditure was still a major financial problem for patients. Limited diagnosis and treatment options in county general hospitals and inadequate implementation of the new policy resulted in higher inpatient expenditures and limited reimbursement. Comprehensive control models are needed to effectively decrease the financial burden on all TB patients.
结核病（TB）在中国仍是一个重大的公共卫生问题。为了扩大结核病控制，一个名为“中国盖茨基金会结核病控制合作项目”的创新项目于 2009 年启动。在项目的第二阶段，实施了新型农村合作医疗（NCMS）报销比例提高的政策。本文旨在通过与基线数据比较，探讨这一改革如何通过比较来影响结核病患者的经济负担。
在两次横断面调查中，通过现有的 NCMS 常规数据系统，分别在干预前（2010 年 1 月至 2012 年 12 月）和干预后（2014 年 4 月至 2015 年 6 月）收集了 313 名结核病住院患者的定量数据，其中 117 名住院患者在项目中。定性数据收集包括 11 次焦点小组讨论。使用非补偿费用率（NER）、有效报销率（ERR）和自付费用（OOP）占人均家庭收入的百分比这三个主要指标来衡量干预的影响，将干预后数据与基线数据结合起来进行分析。使用 SPSS 22.0 进行描述性分析和非参数检验（Mann-Whitney U 检验）对定量数据进行分析，使用 Nvivo10 对定性数据进行主题框架分析。
纳入方案内的住院服务的名义报销率不低于 80%。住院总费用大幅增加，平均增长率为 11.3%。对于所有结核病住院患者，住院费用的 ERR 从 52%增加到 66%。与项目外的住院患者相比，新政策覆盖的住院患者的 ERR 更高（78%），自付费用下降更为明显。此外，他们的经济负担明显减轻。
虽然新的报销政策使结核病患者的住院费用名义报销率大大提高，但住院自费支出仍是患者面临的主要经济问题。县级综合医院的诊断和治疗选择有限，以及新政策的执行不足，导致住院费用增加和报销有限。需要综合控制模式来有效减轻所有结核病患者的经济负担。
