摘要
目的:比较浙江省龙游县肺结核诊疗“零负担”策略实施前后各项肺结核防治指标的变化情况,为制订新时期肺结核防控措施提供科学依据。方法:通过“中国疾病预防控制信息系统”子系统“结核病管理信息系统”收集2016—2022年浙江省衢州市各县(市、区)和与龙游县接壤县区(包括遂昌县、兰溪市、婺城区、建德市)的肺结核报告发病数据,以及现住址为龙游县的肺结核患者的本县收治率和治疗转归数据;常住人口数来源于当地统计年鉴;龙游县肺结核患者诊疗费用数据来自龙游县人民医院信息管理系统;肺结核患者的中断治疗率、政策满意度调查由定点医院与社区随访医生调查收集。比较龙游县肺结核诊疗“零负担”策略实施前(2016—2018年)和实施后(2020—2022年)肺结核患者诊疗费用、肺结核报告发病率、本县收治率、治疗转归等指标情况,分析该策略的实施效果。结果:肺结核患者个人支付费用总额在“零负担”策略实施前分别为:2016年830322.45元,2017年833450.10元,2018年792879.99元,患者人均自付费用分别为3075.27元、3281.30元、3523.91元。“零负担”策略实施后,普通肺结核患者个人支付费用比例降低到0,县财政兜底费用逐年下降(2020—2022年分别为492160.29、401349.56、389319.42元)。2016年龙游县肺结核报告发病率为74.17/10万(270/36.4万),到2022年降低至47.21/10万(169/35.8万),差异有统计学意义(χ_(趋势)^(2)=43.962,P<0.001);报告肺结核患者本地收治率由2016年的74.81%(202/270)明显提高到2022年的93.49%(158/169),差异有统计学意义(χ_(趋势)^(2)=64.483,P<0.001);报告肺结核患者中断治疗率由2016年的6.30%(17/270)明显降低到2022年的1.18%(2/169),差异有统计学意义(χ_(趋势)^(2)=17.965,P=0.003)。结论:浙江省龙游县肺结核诊疗“零负担”策略的实施降低了肺结核患者医疗负担,提高了肺结核患者本地收治率,降低了患者中断治疗率及总体肺结核报告发病率,策略实施效果初显。
Objective:To compare the changes in tuberculosis prevention and control indicators before and after the implementation of the“Zero Burden”strategy for tuberculosis diagnosis and treatment in Longyou County,Zhejiang Province,in order to provide scientific basis for formulating new tuberculosis prevention and control measures in a new stage.Methods:The reported incidence data of tuberculosis in all counties(cities,districts)of Quzhou City and counties bordering Longyou County(including Suichang County,Lanxi City,Wucheng District,and Jiande City)in Zhejiang Province from 2016 to 2022,as well as the admission rate and treatment outcome data of tuberculosis patients currently residing in Longyou County,were collected through the Tuberculosis Management Information System,a subsystem of China Disease Prevention and Control Information System.The number of permanent residents came from the local statistical yearbook.The data of diagnosis and treatment cost of pulmonary tuberculosis patients in Longyou County were from the information management system of Longyou County People’s Hospital.The interruption rate of treatment and policy satisfaction of pulmonary tuberculosis patients were mainly collected through surveys conducted by follow-up doctors in designated hospitals and community.Compare the diagnosis and treatment costs of tuberculosis patients,reported incidence rate of tuberculosis,admission rate of the county,treatment outcome and other indicators before(2016-2018)and after(2020-2022)the implementation of the“Zero Burden”strategy for tuberculosis diagnosis and treatment in Longyou County,and analyzed the implementation effect of the strategy.Results:Before the implementation of the“Zero Burden”strategy,the total personal payment expenses for tuberculosis patients were RMB 830322.45 yuan in 2016,RMB 833450.10 yuan in 2017,and RMB 792879.99 yuan in 2018.The personal payment expenses per tuberculosis patient were RMB 3075.27 yuan in 2016,RMB 3281.30 yuan in 2017 and RMB 3523.91 yuan in 2018.After the implementation of the“Zero Burden”strategy,the proportion of personal payment expenses for ordinary tuberculosis patients decreased to 0,and the county’s financial support expenses decreased year by year(RMB 492160.29 yuan,RMB 401349.56 yuan,and RMB 389319.42 yuan respectively from 2020 to 2022).The reported incidence rate of pulmonary tuberculosis in Longyou County was 74.17/105(270/364000)in 2016,and decreased to 47.21/105(169/358000)in 2022,the difference was statistically significant(χ_(Trend)^(2)=43.962,P<0.001);the local admission rate of reported pulmonary tuberculosis patients had significantly increased from 74.81%(202/270)in 2016 to 93.49%(158/169)in 2022(χ_(Trend)^(2)=64.483,P<0.001);and the reported interruption rate of treatment for pulmonary tuberculosis patients significantly decreased from 6.30%(17/270)in 2016 to 1.18%(2/169)in 2022(χ_(Trend)^(2)=17.965,P=0.003).Conclusion:The implementation of the“Zero Burden”strategy for tuberculosis diagnosis and treatment in Longyou County,Zhejiang Province reduced the medical burden of tuberculosis patients,increased the local admission rate,reduced the rate of patients’treatment interruption and the overall reported incidence rate of tuberculosis,and the implementation effect of the strategy has appeared tentatively.
作者
王莉燕
周慧
吴倩
郝晓刚
陆冰欣
陈彬
Wang Liyan;Zhou Hui;Wu Qian;Hao Xiaogang;Lu Bingxin;Chen Bin(Department of Infectious Disease Prevention and Control,Longyou Center for Disease Control and Prevention,Zhejiang Province,Longyou 324400,China;Institute of Tuberculosis Prevention and Control,Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou 310051,China;Department of AIDS and Tuberculosis Control and Prevention,Quzhou Center for Disease Control and Prevention,Zhejiang Province,Quzhou 324000,China)
出处
《中国防痨杂志》
CAS
CSCD
北大核心
2024年第4期418-423,共6页
Chinese Journal of Antituberculosis
基金
国家卫生健康委-浙江省卫生健康委省部共建基金项目(WKJ-ZJ-2118)
浙江省软科学研究计划(2024C35082)。
关键词
结核
肺
费用
医疗
卫生政策
评价研究
Tuberculosis,pulmonary
Fees,medical
Health policy
Evaluation studies
