A Survey On The Economic Burden And Influencing Factors Of Tuberculosis Patients In Five Counties In Xinjiang

Objective:In order to understand the total cost related to the diagnosis and treatment of tuberculosis patients in the designated medical institutions in the five counties of Xinjiang was obtained,including direct and indirect costs;as well as factors affecting the total,direct and indirect costs of patients;and to obtain the proportion of the total cost due to TB in household income and its influencing factors.Methods:This survey based on the "study on the status of catastrophic expenditure on tuberculosis patients in China and its influencing factors",selected five counties in the Xinjiang Uygur Autonomous Region to investigate.The research was conducted by combining institutional questionnaire,electronic medical record database and patient's personal questionnaire.The institutional questionnaire was obtained by the self-administered questionnaire;the individual questionnaire was investigated by the unified trainer in the way of face-to-face inquiries;for the medical institutions with electronic medical records,the relevant information of the corresponding diagnosis,clinical examination,treatment and cost should be extracted.EpiData is used to set up a database and make a double entry comparison.Data analysis is carried out by SAS9.4.The data are described by descriptive analysis,and directly by statistical graph and statistical table,he rank sum test of non normal variables,the test of the rate of the use of chi square test or Fisher accurate test,the test level is alpha =0.05.The Logistic regression analysis was used to analyze the factors influencing the proportion of total cost due to TB in annual household income.Results:A total of 251 patients were investigated.They were all non multi drug resistant patients,of whom 94.8%were newly diagnosed.Of the 251 patients surveyed,130(51.8%)were male,slightly more than women.112(44.6%)cases of patients over 60 years old.Among the patients,there were 96(38.3%)cases of occupation for farmers and herdsmen,accounting for the highest proportion,followed by 59(23.5%)houseworker and unemployed people.From the educational level,30.7%of the patients belong to primary school education,accounting for the highest proportion,followed by junior high school education,accounting for 26.3%.Of the 251 patients,94.8%participated in the medical insurance,and 70.1%were in NCMS.The total cost of self payment for 251 patients was 9291.7 yuan per person,the median[quartile(Q1,Q3)]was 3949.4(1648.610721.9),which was mainly composed of direct medical expenses(46.3%),followed by indirect cost(37.2%).42.9%of the total cost of self payment occurs before the patient starts treatment at the designated medical institution.The direct cost of the investigated patients was 5837.8 yuan,while the median[quartile(Q1,Q3))was 2290.9(440.05063.3)yuan.58.2%of the direct cost occurs before the patient starts treatment in a designated hospital.The indirect cost of the investigated patients was 3453.9 yuan per capita and the median[quartile(Q1,Q3))was 495.7(81.42696.2)yuan.Among the 251 patients,the total cost of 150 patients accounted for more than 20%of the annual household income.The annual household income of patients in five counties decreased by 5217 yuan after the disease,which was 13.2%lower than that before the disease.The per capita annual income of the patients decreased by 6059.9 yuan,which was 34%lower than that before the disease.Of the 251 patients,51(20.3%)of the patients were unemployed,of which 31 were male,accounting for 60.8%of the unemployed.43 patients borrowed money for TB treatment,and 27 patients had sold property.Educational level,the number of medical visits before the diagnosis,the number of days of hospitalization and the days of loss of working days are the main factors that affect whether the total cost is more than 20%in the annual household income.The higher the educational level is,the smaller the risk of total cost exceeding 20%of the annual household income.The number of visits before hospitalization,hospitalization and the number of missed days were positively correlated with the total cost exceeding 20%of annual household income.Conclusion:This study found that the economic burden of pulmonary tuberculosis patients in five counties of Xinjiang autonomous region is relatively heavy,on the one hand,the direct medical cost is high,on the other hand,the indirect economic burden is heavy.The cost of the patients before the treatment is higher in the total cost.It is necessary to improve the diagnosis ability of the medical institutions at the grass-roots level,reduce the number of patients before diagnosis,reduce the patient's hospitalization,shorten the time of work,reduce the economic burden of the patients and families,and reduce the proportion of the total cost due to TB in the annual household income.This study did not observe the role of medical insurance in reducing the proportion of total cost due to TB in the annual household income.It is necessary to expand the reimbursement range of medical insurance to tuberculosis examination and treatment,increase the proportion of reimbursement,and reduce the direct medical cost of tuberculosis patients.The indirect economic burden has a significant impact on the total economic burden of the patients.The current guarantee policy lacks the subsidy to the indirect expenses of the patients.It is necessary to strengthen the communication and coordination with the civil affairs department and explore the long-term mechanism to reduce the indirect economic burden of the patients.