Medical Expenses, Burden Of Disease And Compensation Of MDR-TB Patients

Background and Study ObjectMDR-TB (Multi-drug resistant tuberculosis MDR-TB) refers to which is caused by Mycobacterium tuberculosis and at least resistant to both isoniazid and rifampicin. MDR-TB is a serious infectious disease hazard to human health. It is one of key diseases which the government wants to control. Tuberculosis drug resistance is serious in China. The national TB drug resistance according to the baseline survey data showed that 8.32% patients are Multi-drug resistance tuberculosis in 2007-2008. There are about 120000 new patients each year. Prevention and control the MDR-TB has been the key work in tuberculosis in China.Because MDR-TB treatment period is so long, and second-line drugs are especially expensive, treatment of the disease has laid heavy financial burden to the patients and their families.This study mainly describes the current medical costs and economic burden of disease of the multi-drug resistant tuberculosis patients, analyses the health insurance system at present, with the purpose of finding out the economic burden reduction approach to patients and providing references to policy making of the prevention and treatment of multi-drug resistant TB. The following are the three objectives of this study:1) The present situation of the treatment costs of the MDR-TB patients.2) The analysis of the compensation for medical expenses of the MDR-TB patients at present. 3) The study on the improvement of the compensation to MDR-TB patients.MethodologyThis study mainly analyzed the medical expense, economic burden of disease and compensation of medical expense of the MDR-TB patients, both quantitative and qualitative analysis methods were used to analyze the three questions. And using the method of case study explain and added the results. Based on the MDR-TB baseline survey data, tuberculosis control levels, geographic distribution and socio-economic conditions, this study selected Hohhot city of Inner Mongolia Autonomous Region, Kaifeng city of Henan province, Lianyungang city of Jiangsu province as the project cities. We chose patients whom had been treated in TB hospital from January 1,2006 to Surveying date (September to December,2009). This study investigated 44 MDR-TB patients in total. But only 38 met the analytical standards.24 pieces of list of hospital costs were also copied.The data were mainly from the review of existing literature, Face to face surveys with patients, list of hospital costs, the key informants' interview and the local health insurance policy documents. The field data were collected by the teachers and students in center for health management and policy of Shandong University and staff from Tuberculosis Prevention and Control Center of Chinese Center for Disease Control and Prevention. Data were analyzed by SPSS16.0 software, and used descriptive statistics to do quantitative data analysis. Use the semi-structured questionnaire to investigate the key informants and analysis by Nvivo.Results1. The medical expense is from 300 yuan to 60,000 yuan, the median is 7,720 yuan. The average daily out-patient cost is 18.8 yuan. The average daily hospitalization cost is 18.8 yuan.2. Treatment time, hospitalization, hospital treatment behavior affect the medical expenses. The longer the treatment of patients, the higher medical expenses are. Hospitalization costs make up the most part of medical costs in hospitalized patients. Medicine costs account for 60% of the hospital expense.70.8% patients still take isoniazid or rifampin; the proportion of second-line anti-TB drugs in total drug cost is 19.2%.3. The proportion of the average monthly medical cost in patients' non-food expenditure is 48.9%.22 families are caught with catastrophic expenditure because of treatment of MDR-TB.4. At present, health care compensation policy for multi-drug resistant TB patients is only made in Kaifeng City. The other two do not have the plan, but it could be considered in Lianyungang. The proportion of reimbursement in the three major health insurances is too low for MDR-TB patients. Basic medical insurance for urban workers reimbursement proportion is the highest, which is about 60%. Only 13 patients get compensation in 38 patients. The patients of catastrophic medical expenses drop from 11 to 8 after getting compensation.3 patients who have basic medical insurance for urban workers ease the burden of disease.Conclusions and SuggestionsThe medical expense of the MDR-TB patients is very high. The TB hospital treatment is not standard. And the compensation policy for MDR-TB is lack. Patients get the compensation is limit, and the burden of disease is still heavy. Therefore potential suggests are as follows:1. Strengthen the publicity of TB knowledge, and regulate the treatment of patients' behavior.2. To introduce of novel technologies for rapid detection of drug resistance for tuberculosis. The diagnosis and treatment to MDR-TB should be improved in the TB hospitals, as well.3. To increase the medical insurance coverage, adding MDR-TB to major diseases. Outpatient and inpatient cost to patients are included in the reimbursement category to increase patients'proportion of compensation.