International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.
Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India.
Front Public Health. 2021 Feb 15;9:614466. doi: 10.3389/fpubh.2021.614466. eCollection 2021.
One of the targets of the END-TB strategy is to ensure zero catastrophic expenditure on households due to TB. The information about household catastrophic expenditure is limited in India and, therefore difficult to monitor. The objective is to estimate household and catastrophic expenditure for Tuberculosis using national sample survey data. For arriving at out-of-pocket expenditure due to tuberculosis and its impact on households the study analyzed four rounds of National Sample Survey data (52nd round-1995-1996, 60th round-2004-2005, 71st round-2014-15, and 75th round 2017-2018). The household interview survey data had a recall period of 365 days for inpatient/ hospitalization and 15 days for out-patient care expenditure. Expenditure amounting to >20% of annual household consumption expenditure was termed as catastrophic. A 5-fold increase in median outpatient care cost in 75th round is observed compared to previous rounds and increase has been maximum while accessing public sector. The overall expense ratio of public v/s private is 1:3, 1:4, 1:5, and 1:5, respectively across four rounds for hospitalization. The prevalence of catastrophic expenditure due to hospitalization increased from 16.5% (52nd round) to 43% (71st round), followed by a decline to 18% in the recent 75th round. Despite free diagnostic and treatment services offered under the national program, households are exposed to catastrophic financial expenditure due to tuberculosis. We strongly advocate for risk protection mechanisms such as cash transfer or health insurance schemes targeting the patients of tuberculosis, especially among the poor.
终结结核病战略的目标之一是确保结核病患者家庭零灾难性支出。印度关于家庭灾难性支出的信息有限，因此难以监测。目的是利用国家抽样调查数据估算结核病的家庭和灾难性支出。为了确定因结核病导致的自付支出及其对家庭的影响，本研究分析了四轮国家抽样调查数据（第 52 轮-1995-1996 年、第 60 轮-2004-2005 年、第 71 轮-2014-15 年和第 75 轮-2017-2018 年）。家庭访谈调查数据的回忆期为住院/住院 365 天，门诊护理支出 15 天。将支出超过年度家庭消费支出 20%的情况称为灾难性支出。与前几轮相比，第 75 轮门诊护理费用中位数增加了 5 倍，在使用公共部门时增幅最大。在住院方面，四轮的公共部门与私营部门的总费用比分别为 1:3、1:4、1:5 和 1:5。由于住院而导致灾难性支出的患病率从第 52 轮的 16.5%上升到第 71 轮的 43%，随后在最近的第 75 轮下降到 18%。尽管国家方案提供了免费的诊断和治疗服务，但结核病患者家庭仍面临灾难性的财政支出。我们强烈主张采取风险保护机制，例如向结核病患者，特别是贫困患者提供现金转移或医疗保险计划。
