| 1. BackgroundChina is one of the 22 high-burden countries for tuberculosis (TB) disease with the second highest TB burdens over the world, and facing big challenges in prevention and control of this disease. In recent years, Shanghai has become one of the lowest epidemic areas as a result of the remarkable achievements of TB control. However, the TB prevalence among migrants is on the rise, accompanied by a sharp rise in the number of migrants in Shanghai. Migration TB patients has been an important disadvantaged population in Putuo District and therefore attract a lot of efforts from the department of disease control. The management of the migrants appears difficult due to the social characteristics of this population. Since TB is a poverty-related condition and poverty is the main effect of therapeutic compliance, the research on the economic burden of migration cases has important practical significance:to determine the problems related the TB control project for poor and vulnerable groups, to provide a scientific basis for policy formulation, and to provide evidences to reduce the economic burden of TB disease, as well as stop TB.2. ObjectivesTo understand the TB prevalence of migrants with the purpose of providing the background information for further research by analyzing the patients registered from 2004 to 2008 in Putuo District;To understand the economic burdens of migrants TB patients by analyzing the direct and indirect economic burden that occurs before TB diagnosis and during TB treatment among the newly registered migrants TB patients with initial treatment registered in Putuo District in 2008;To identify the factors that may affect the economic burden of the migration patients in order to provide the theoretical basis of improving therapeutic management and relieving economic burden for patients. 3. MethodsBased on the surveillance data of the migrants TB patients from 2004 to 2008, this study describes the demographic and socioeconomic characteristics, illness symptoms, treatment outcome.A retrospective study, which could acquire the information about the newly registered initial migrants TB patients with completed treatment in 2008, was conducted to understand the situation of individuals and families living with TB, the process of diagnosis and treatment, the medical costs related to TB diagnosis and treatment, and the economic burden they had; Medical charts of outpatient were reviewed to understand the process of treatment in the reference hospitals, the items of diagnostic tests, medications, and related expenses; Both receipts of original cost and data of reports could provide the information about the cost of diagnosis and treatment, the expense reduced by the government, and the assistance of the project; With all above information, this study evaluated the economic burden of the TB treatment, analyzed the potential influence factors, and discussed the policies recommendations of TB. Data were analyzed by SPSS 15.0. The quantitative variables were depicted by mean, standard deviation and median. Due to the skewed distribution of costs, rank sum test was used to compare the difference among groups, and Student-Newman-Keuls (SNK) was used to exam the differences between each two groups. The qualitative variables were depicted using frequencies, proportions, etc. Chi-square test or Fisher’s exact probability was used to test the difference among groups of those data.4. Main results1) The historical data from 2004 to 2008 has demonstrated that the notification number of newly registered migrants TB patients with active tuberculosis increased with the time in Putuo District. There was 63 cases in 2004, while 134 in 2008. The number of smear positive TB patients was also on the rise, and the majority was on the initial stage of treatment. The data also showed that the rate of completed treatment increased every year, as well as the rate of negative conversion. The number of migration cases who were not adherent to anti-TB treatment was very common. It suggested that the current management model of migrants TB patients was obviously effective, while the control of migrants TB patients was still the focus of TB prevention and treatment in Putuo District.2) A total of 97 patients, whose basic situation was in accordance with the migrants TB patients in Putuo District and Shanghai, were enrolled into the retrospective study. Majority of them originally came from the areas of high TB prevalence, with average ages of 33 years old, and most of them were men. Most of them had a medium degree of education, and they took part in service and production transportation industry, without any medical insurance. The research showed that the average per capita income was less than that of Shanghai resident population, and only 17.53% of the patients received the supports from their relatives and friends. Consequently, the migrants with middle or low income that was most important disadvantaged population in the city.3) This result identified that the median of the total economic burden of TB disease was 5176.70 RMB, with direct and indirect economic burden to be 3777.60 and 6840.91 RMB respectively. With regard to direct economic burden, it was 2452.33 RMB in median while the non-medical burden was 1000 RMB. The total economic burden of TB accounted for 16.29% of the annual household income, with 12.94% for direct costs and 8.23% from indirect costs. It appears that direct medical expenses became the predominant economic burden of TB disease for migrants, and most of them were from TB treatment. The medical cost was high before diagnosis. Gender, age, education, hospitalizations during the treatment, awareness of their own medical insurance might be the potential factors that may affect the medial burden.4) The proportion of treatment costs from annual household income decreased from 8.23% to 3.55% after reducing the reimbursement. It showed that the DOTs could partly reduce the economic burden of TB patients of migrants. However, the effects may be depended on if there is a delay for free diagnosis and treatments.5) The global funding project was found to be helpful to reduce the economic burden of disease. However, it still required the support of government departments in order to ensure the continuity of the related policy.5. Conclusions and suggestions1) The TB epidemic situation of the migrants increased every year due to their characteristics of highly floating and difficult management, therefore great efforts should be made by the government with the purpose of issuing related laws, regulations and regulatory documents that address this population.2) Since direct medical cost of TB put a heavy economic burdens for migration TB patients, social power should be mobilized in order to create the atmosphere of prevention and treatment for migration patients, to improve the aware of related knowledge and policy, to reduce the delayed treatment, to simplify the treatment procedure, to strengthen the professional diagnosis and treatment, and to reduce the cure costs.3) Since the non-personalized government cuts plan and delayed apply for reimbursement made the patients do not get timely assistance, effective relief form should be explored to reduce the economic burden of the TB patients during the period of treatment.4) Since the Global Funding Project offered effective experience of improving the therapeutic compliance and cure rate for migrants TB patients, the experience should be converted to feasibility policies under the guidance of the government in order to ensure the sustainability of the project effects.5) Further researches should be carried out to explore the reasons related to social determines, such as quite a few of patients "don’t know their medical insurance", and to develop the corresponding countermeasures. |
PDF Full Text Request