Du Rong, Ma Xiaoxue, Huang Aiju, Chen Huijuan, Guo Xueli, Zhou Jian, Li Jinlan, Wang Weibing, Zhao Qi
School of Public Health, Fudan University, Shanghai, China.
NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
Epidemiol Infect. 2024 Dec 11;152:e141. doi: 10.1017/S0950268824001316.
Despite global efforts to end tuberculosis (TB), the goal of preventing catastrophic health expenditure (CHE) due to TB remains unmet. This cross-sectional study was conducted in Guizhou Province, Southwest China. Data were collected from the Hospital Information System and a survey of TB patients who had completed standardized antituberculosis treatment between January and March 2021. Among the 2 283 participants, the average total expenditure and out-of-pocket expenditure were $1 506.6 (median = $760.5) and $683.6 (median = $437.8), respectively. Health insurance reimbursement reduced CHE by 16.8%, with a contribution rate of 24.9%, and the concentration index changed from -0.070 prereimbursement to -0.099 postreimbursement. However, the contribution of health insurance varied significantly across different economic strata, with contribution rates of 6.4% for the lowest economic group and 53.1% for the highest group. For patients from lower socioeconomic strata, health insurance contributed 10.7% to CHE in the prediagnostic phase and 23.5% during treatment. While social health insurance alleviated the financial burden for TB patients, it did not provide sufficient protection for those in lower economic strata or during the prediagnostic stage. This study underscores the need for more effective and equitable subsidy policies for TB patients .
尽管全球都在努力终结结核病，但预防因结核病导致的灾难性医疗支出（CHE）这一目标仍未实现。本横断面研究在中国西南部的贵州省开展。数据收集自医院信息系统以及对2021年1月至3月间完成标准化抗结核治疗的结核病患者的一项调查。在2283名参与者中，平均总支出和自付支出分别为1506.6美元（中位数 = 760.5美元）和683.6美元（中位数 = 437.8美元）。医疗保险报销使灾难性医疗支出降低了16.8%，贡献率为24.9%，集中指数从报销前的-0.070变为报销后的-0.099。然而，医疗保险的贡献在不同经济阶层中差异显著，最低经济组的贡献率为6.4%，最高经济组为53.1%。对于社会经济阶层较低的患者，医疗保险在诊断前阶段对灾难性医疗支出的贡献率为10.7%，治疗期间为23.5%。虽然社会医疗保险减轻了结核病患者的经济负担，但它并未为经济阶层较低的患者或诊断前阶段提供足够的保障。本研究强调需要为结核病患者制定更有效、更公平的补贴政策。
