Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi.
Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
PLoS One. 2019 Dec 31;14(12):e0225712. doi: 10.1371/journal.pone.0225712. eCollection 2019.
Chronic cough is a distressing symptom and a common reason for people to seek health care services. It is a symptom that can indicate underlying tuberculosis (TB) and/or chronic airways diseases (CAD) including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis. In developing countries including Malawi, provision of diagnostic services and clinical management of CAD is rudimentary, so it is thought that patients make costly and unyielding repeated care-seeking visits. There is, however, a lack of information on cost of illness, both direct and indirect, to patients with chronic cough symptom. Such data are needed to inform policy-makers in making decisions on allocating resources for designing and developing the relevant health care services to address universal coverage programmes for CAD. This paper therefore explores health seeking costs associated with chronic cough and explores information on usage of the coping mechanisms which indicate financial hardship, such as borrowing and selling household assets.
This economic study was nested within a community-based, population-proportional cross-sectional survey of 15,795 individuals aged 15 years and above, in Dowa and Ntchisi districts. The study sought to identify individuals with symptoms of chronic airways disease whose health records documented at least one of the following diagnoses within the previous year: TB, Asthma, COPD, Bronchitis and Lower Respiratory Tract Infection (LRTI). We interviewed these chronic coughers to collect information on socioeconomic and socio-demographic characteristics, health care utilization, and associated costs of care in 2015. We also collected information on how they funded their health seeking costs.
We identified 608 chronic coughers who reported costs in relation to their latest confirmed diagnosis in their hand-held health record. The mean care-seeking cost per patient was US$ 3.9 (95% CI: 3.00-5.03); 2.3 times the average per capita expenditure on health of US$ 1.69. The largest costs were due to transport (US$ 1.4), followed by drugs (US$ 1.3). The costs of non-medical inputs (US$ 2.09) was considerable (52.3%). Nearly a quarter (24.4%) of all the patients reportedly borrowed or/and sold assets/property to finance their healthcare. CCs with COPD and LRTI had 85.6% and 62.0% lower chance of incurring any costs compared with the TB patients and any patients with comorbidity had 2.9 times higher chance to incur any costs than the patients with single disease. COPD, Bronchitis and LRTI patients had 123.9%, 211.4% and 87.9% lower costs than the patients with TB. The patients with comorbidity incurred 53.9% higher costs than those with single disease.
The costs of healthcare per chronic cougher was mainly influenced by the transport and drugs costs. Types of diseases and comorbidity led to significantly different chances of incurring costs as well as difference in magnitude of costs. The costs appeared to be unaffordable for many patients.
慢性咳嗽是一种令人痛苦的症状，也是人们寻求医疗服务的常见原因。它是一种可能表明潜在结核病（TB）和/或慢性气道疾病（CAD）的症状，包括哮喘、慢性阻塞性肺疾病（COPD）和支气管扩张症。在包括马拉维在内的发展中国家，CAD 的诊断服务和临床管理都很基础，因此人们认为患者会进行昂贵且无益的反复寻求医疗服务。然而，对于有慢性咳嗽症状的患者，直接和间接的疾病负担信息却很缺乏。这些数据对于决策者在制定和开发相关医疗保健服务以实现 CAD 全民覆盖方案方面分配资源的决策很有必要。因此，本文探讨了与慢性咳嗽相关的医疗保健费用，并探讨了使用表明经济困难的应对机制的信息，例如借款和出售家庭资产。
这项经济研究是嵌套在一个基于社区的、人口比例的横断面调查中，该调查对达沃和恩奇西地区的 15795 名 15 岁及以上的个体进行了调查。该研究旨在确定有慢性气道疾病症状的个体，其健康记录在过去一年中至少记录了以下诊断之一：结核病、哮喘、COPD、支气管炎和下呼吸道感染（LRTI）。我们对这些慢性咳嗽者进行了访谈，以收集与 2015 年的社会经济和社会人口特征、卫生保健利用以及相关医疗费用相关的信息。我们还收集了他们如何为医疗费用提供资金的信息。
我们确定了 608 名慢性咳嗽者，他们根据自己的最新确诊诊断报告了相关费用。每位患者的平均医疗费用为 3.9 美元（95%CI：3.00-5.03）；是人均卫生支出 1.69 美元的 2.3 倍。最大的费用是交通费用（1.4 美元），其次是药物费用（1.3 美元）。非医疗投入（2.09 美元）的费用相当可观（52.3%）。近四分之一（24.4%）的患者据称借款或/和出售资产/财产以支付医疗费用。与结核病患者相比，COPD 和 LRTI 患者的任何费用发生几率分别低 85.6%和 62.0%，而任何合并症患者的任何费用发生几率比单一疾病患者高 2.9 倍。COPD、支气管炎和 LRTI 患者的费用分别比结核病患者低 123.9%、211.4%和 87.9%。合并症患者的费用比单一疾病患者高 53.9%。
每位慢性咳嗽者的医疗保健费用主要受交通和药物费用的影响。疾病类型和合并症导致了费用发生几率和费用幅度的显著差异。这些费用对许多患者来说似乎难以承受。
