摘要
目的分析上海市奉贤区肺结核患者经济负担及其影响因素。方法搜集2018年上海市奉贤区疾病预防控制中心(简称“疾控中心”)登记并进行社区管理且符合入选标准的136例初复治肺结核患者,采用自行设计的调查问卷了解患者的基本资料(包括性别、年龄、有无医疗保险、家庭灾难性卫生支出、有无并发症等),并记录诊疗过程中所有的直接费用、间接费用。采用SPSS17.0软件进行数据的统计学分析及最优尺度回归分析,以P<0.05为差异有统计学意义。结果剔除疗程中因病死亡和医疗费用数据不全者各1例,最终收集到完成抗结核药物治疗且资料完整的134例患者,其中户籍患者88例,非户籍患者46例。肺结核患者例均年收入55181.46元(人民币,下同),平均家庭收入112937.91元。例均总支出费用32035.99元,包括例均直接费用24363.97元和间接费用7672.02元;户籍患者的总支出费用中位数(四分位数)[M(Q1,Q3)]为25635.25(8361.82,45314.05)元,与非户籍患者[18847.43(9016.25,31894.65)元]比较,差异无统计学意义(Z=-0.984,P=0.325),但直接费用[19336.34(7756.65,36700.57)元]高于非户籍患者[11658.03(6716.38,20072.61)元](Z=2.329,P=0.020),而间接费用[1000.00(0.00,4075.00)元]低于非户籍患者[3000.00(75.00,13500.00)元](Z=-2.773,P=0.006)。例均医疗保险报销经费占总支出费用的23.75%(7607.26/32035.99),政府减免经费占4.55%(1458.03/32035.99),自付费用占71.70%(22970.70/32035.99),且自付费用占家庭年均收入的20.34%(22970.70/112937.91);户籍患者医疗保险报销金额[2703.00(1024.00,10917.00)元]及政府减免金额[1210.50(820.25,1721.75)元]与非户籍患者[分别为179.00(0.00,1218.00)元和1480.50(1328.75,1802.50)元]差异均有统计学意义(Z值分别为-5.291和-2.962;P值分别为0.000和0.003)。最优尺度回归分析结果显示,患者就诊区级机构[11535.48(6622.96,22741.41)元]、每日规范服药[14147.86(6878.47,27395.80)元]、无住院治疗[6395.98(4425.99,8878.89)元]、住院天数0d[6395.98(4425.99,8878.89)元]、无住院次数[6395.98(4425.99,8878.89)元]、疗程时间≤8个月[11474.18(6563.88,22880.65)元]、自评病情程度重[8726.80(4666.35,20642.64)元]、无家庭灾难性卫生支出[11474.18(6818.67,22880.65)元]、无医疗保险[7074.25(4741.36,8660.69)元]的直接医疗费用均明显低于就诊市级机构[15550.02(8456.05,37171.31)元]、不规律服药[15107.08(8901.53,34197.84)元]、有住院治疗[19982.64(9676.31,35013.72)元]、住院天数>30d[56713.89(37977.08,101972.01)元]、住院次数3~5次[53899.46(36421.73,113670.87)元]、疗程时间>8个月[18925.76(8616.10,36823.34)元]、自评病情程度轻[20070.70(9456.83,44849.70)元]、有家庭灾难性卫生支出[35562.35(20704.26,55516.06)元]、有医疗保险[14907.71(7335.28,29653.38)元](F值分别为5.794、5.983、6.346、11.102、70.825、8.087、11.636、31.912、5.851,P值分别为0.044、0.037、0.034、0.021、0.000、0.036、0.011、0.000、0.039)。结论奉贤区肺结核患者的诊治经济负担较重,患者负担费用高低与主要就诊机构、每日规范服药、住院治疗、累计住院天数、住院次数、疗程时间、有无医疗保险、自评病情程度、有无家庭灾难性卫生支出有关。
Objective To understand the economic burden of the patients with pulmonary tuberculosis (PTB) and its influencing factors in Fengxian District of Shanghai.Methods The study enrolled 136 initial treatment or re-treatment PTB patients, who were notified in Fengxia District CDC of Shanghai and managed by community health centers in 2018.A self-designed questionnaire was used to investigate the basic information of the patients, including sex, age, if having health insurance or not, family catastrophic health expenditure, if having complications or not, etc.;the related direct and indirect costs of the patients in the process of diagnosis and treatment were recorded. The SPSS 17.0 software was used to do the data statistical analysis and the optimal scale regression analysis.Results Two patients were excluded from the study, one died during treatment while the other was due to incomplete data on medical expenses. Finally, a total of 134 patients, who completed the whole course of anti-TB treatment and had complete information, were involved into the analysis. Among them, 88 patients had local household registration while 46 patients did not have. The average annual income per PTB patient was RMB 55181.46 yuan and the average annual income per family of the PTB patients was RMB 112937.91 yuan. The average expenses per patient was RMB 32035.99 yuan, including RMB 24363.97 yuan direct expenses and RMB 7672.02 yuan indirect expenses. The median (Q1, Q3) of total cost in the patients who had local household registration was RMB 25635.25 (8361.82,45314.05) yuan while it was RMB 18847.43 (9016.25,31894.65) yuan in those patients who did not have local household registration, there was no significant difference between the two groups of patients (Z=-0.984, P=0.325);however, the direct cost in the patients who had local household registration (RMB 19336.34 (7756.65,36700.57) yuan) was significantly higher than that who did not have local household registration (RMB 11658.03 (6716.38,20072.61) yuan)(Z=2.329, P=0.020), while the indirect cost in the patients who had local household registration (RMB 1000.00 (0.00,4075.00) yuan) was significantly lower than that who did not have local household registration (RMB 3000.00 (75.00,13500.00) yuan)(Z=-2.773, P=0.006). 23.75%(7607.26/32035.99) of the average overall expenses was reimbursed by medical insurance, 4.55%(1458.03/32035.99) was paid by government relief funds and 71.70%(22970.70/32035.99) was paid out of patient’s own pocket which occupied 20.34%(22970.70/112937.91) of average annual household income of the patients. The amounts of expenditures which were reimbursed by health insurance and paid by government relief funds in the patients who had local household registration were RMB 2703.00 (1024.00,10917.00) yuan and RMB 1210.50 (820.25,1721.75) yuan,while those were RMB 179.00 (0.00,1218.00) yuan and RMB 1480.50 (1328.75,1802.50) yuan in the patients who did not have local household registration, there were significant difference between the two groups of patients (Z values were -5.291 and -2.962;P values were 0.000 and 0.003, respectively). The results of optimal proportional regression analysis showed that the district-level health facilities in the patients who visited district-level health facilities (RMB 11535.48 (6622.96,22741.41) yuan), costs of standard daily medication (RMB 14147.86 (6878.47,27395.80) yuan), costs without hospitalization (RMB 6395.98 (4425.99,8878.89) yuan), costs with less-one-day hospitalization (RMB 6395.98 (4425.99,8878.89) yuan), costs never hospitalization (RMB 6395.98 (4425.99,8878.89) yuan), costs with treatment duration less than 8 months (RMB 11474.18 (6563.88,22880.65) yuan), costs with severity by self-assessment (RMB 8726.80 (4666.35,20642.64) yuan), costs without family catastrophic health expenditure (RMB 11474.18 (6818.67,22880.65) yuan), costs without medical insurance (RMB 7074.25 (4741.36,8660.69) yuan) were significantly lower than the direct medical expenses in the patients who visited municipal-level health facilities (RMB 15550.02 (8456.05,37171.31) yuan), costs with irregular medication (RMB 15107.080 (8901.53,34197.84) yuan), costs with hospitalization (RMB 19982.64 (9676.31,35013.72) yuan), costs with hospitalization days >30 days (RMB 56713.89 (37977.08,101972.01) yuan), costs with hospitalization for 3-5 times (RMB 53899.46 (36421.73,113670.87) yuan), costs with treatment duration >8 months (RMB 18925.76 (8616.10,36823.34) yuan), costs with mild illness by self-assessment (RMB 20070.70 (9456.83,44849.70) yuan), costs with family catastrophic health expenditure (RMB 35562.35 (20704.26,55516.06) yuan), costs with medical insurance (RMB 14907.71 (7335.28,29653.38) yuan). F values were 5.794, 5.983, 6.346, 11.102, 70.825, 8.087, 11.636, 31.912, 5.851, and P values were 0.044, 0.037, 0.034, 0.021, 0.000, 0.036, 0.011, 0.000, 0.039, respectively.Conclusion The economic burden of diagnosis and treatment of tuberculosis patients in Fengxian District is heavy. The costs of patients’ burden are mainly related to the health facilities that patients seek health care, daily standard medication, hospitalization, accumulated hospitalization days, number of hospitalizations, duration of treatment, medical insurance, self-assessment of the degree of illness, and catastrophic family health expenditure.
作者
徐春华
刘清
王紫纯
邬勇
XU Chun-hua;LIU Qing;WANG Zi-chun;WU Yong(Department of Tuberculosis Control,Shanghai Fengxian District Center for Disease Control and Prevention,Shanghai 201499,China)
出处
《中国防痨杂志》
CAS
CSCD
2019年第9期974-984,共11页
Chinese Journal of Antituberculosis
基金
上海市奉贤区科技发展基金(奉科20171010).
关键词
结核
肺
患病代价
问卷调查
费用
医疗
医疗费用无力承担
小地区分析
因素分析
统计学
Tuberculosis,pulmonary
Cost of illness
Questionnaires
Fees,medical
Medical indigency
Small-area analysis
Factor analysis
statistical
