江苏省肺结核患者住院率和住院费用影响因素分析：一项非对照前后研究。

Factors Influencing Hospitalization Rates and Inpatient Cost of Patients with Tuberculosis in Jiangsu Province, China: An Uncontrolled before and after Study.

机构信息

School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China.

Creative Health Policy Research Group, Nanjing Medical University, Nanjing 211166, China.

出版信息

Int J Environ Res Public Health. 2019 Aug 1;16(15):2750. doi: 10.3390/ijerph16152750.

DOI:10.3390/ijerph16152750

PMID:31374945

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6695970/

Abstract

OBJECTIVE

The China Center for Disease Control and Prevention (CDC) introduced an innovative financing model of tuberculosis (TB) care and control with the aim of standardizing TB treatment and reducing the financial burden associated with patients with TB. This is a study of the pilot implementation of new financing mechanism in Zhenjiang, between 2014-2015. We compared TB hospitalization rates and inpatient service costs before and after implementation to examine the factors associated with hospital admissions. Our goal is to provide evidence-based recommendations for improving TB service provision and cost control.

METHODS

We reviewed new policy documents on TB financing. We conducted a patient survey to investigate the utilization of inpatient services, and patients' out-of-pocket payment for inpatient care. We extracted total medical expenditures of inpatient services from inpatient records of TB designated hospitals.

FINDINGS

63.6% ( = 159) of the surveyed patients with TB were admitted for treatment in 2015, which was higher than that in 2013 (54.8%, = 144). The number of hospital admission was slightly lower in 2015 (1.16 per patient) than in 2013 (1.26 per patient), while the length of hospital stay was longer in 2015 (24 days) than in 2013 (16 days). In 2015, patients from families with low incomes were more likely to be admitted than those from higher income groups (OR = 3.06, 95% CI: 1.12-8.33). The average inpatient service cost in 2015 (3345 USD) was 1.7 times the cost in 2013 (1952 USD). It was found that 96.2% of patients with TB who were from low-income households spent more than 20% of their household income on inpatient care in 2013, versus 100% in 2015.

CONCLUSION

The TB hospital admission rate and total inpatient service cost increased over the study period. The majority of patients with TB, particularly poor patient who used inpatient care, continue to suffer from heavy financial burden.

摘要

目的

中国疾病预防控制中心（CDC）引入了一种结核病（TB）关怀和控制的创新融资模式，旨在规范结核病治疗并减轻结核病患者的经济负担。这是对 2014-2015 年镇江试点实施新融资机制的研究。我们比较了实施前后的结核病住院率和住院服务费用，以研究与住院相关的因素。我们的目标是为改善结核病服务提供和成本控制提供循证建议。

方法

我们审查了结核病融资的新政策文件。我们进行了一项患者调查，以调查住院服务的利用情况以及患者住院治疗的自付费用。我们从结核病定点医院的住院记录中提取了住院服务的总医疗支出。

结果

2015 年接受调查的结核病患者中有 63.6%（=159）住院治疗，高于 2013 年的 54.8%（=144）。2015 年的住院人数略低于 2013 年（每位患者 1.16 人），而住院时间则更长（2015 年 24 天，2013 年 16 天）。2015 年，低收入家庭的患者比高收入群体更有可能住院（OR=3.06，95%CI：1.12-8.33）。2015 年的平均住院服务费用（3345 美元）是 2013 年（1952 美元）的 1.7 倍。研究发现，2013 年，96.2%的低收入家庭结核病患者住院治疗费用超过其家庭收入的 20%，而 2015 年这一比例为 100%。