Study On The Current Situation And Influence Factors Of Direct Economic Burden Of Pulmonary Tuberculosis Patients In Three Counties And Districts Of Yunnan Province

Objective:By investigating the diagnosis information and treatment costs,of tuberculosis patients in three counties and districts of Yunnan province.Understood the direct economic burden of patients' disease,Calculated the incidence of catastrophic expenditures,analyzed the influencing factors of the direct economic burden and catastrophic expenditure of tuberculosis patients.Methods:This study adopted the method of retrospective survey.Selected tuberculosis patients who received anti-tuberculosis treatment in designated hospitals in three counties,namely,mojiang county,lancang county and simao district,and had completed the course of treatment.Through face-to-face questionnaire survey and HIS system in designated hospitals,Investigated the direct economic burden of the disease in the whole process of diagnosis and treatment from symptom presentation to treatment completion,understood the incidence of catastrophic expenditures.Epidata3.1 was used to establish the database and SPSS 17.0 software was used for statistical analysis.Median(quartile),mean,standard deviation and composition ratio were used for statistical description,through chi-square test,rank sum test,binary logistic regression model and other statistical methods,to explore the effects of different sociodemographic characteristics,treatment classification,medical behavior and treatment-related conditions on patients' direct economic burden of disease and catastrophic expenditure.Results:1.A total of 233 patients were included in this study,including 150(64.38%)male patients;average age:47±16 years;165 patients(70.82%)were ethnic minorities;150 cases(64.37%)with primary school education or below;189 patients(81.12%)were farmer;173(74.25%)patients were married;209 patients(89.70%)had the new rural cooperative medical insurance;The median per capita annual income of patients'families was 3333(2000,6000)yuan.2.The median direct economic burden of 233 patients' disease was 7,820(5,269,12,754)yuan,the lowest was 984 yuan and the highest was 61,444 yuan.The median direct medical expenses was 5,879(3957,9938)yuan,accounted for 77.43%,and the median direct non-medical expenses was 1,760(822,3192)yuan,accounted for 22.57%.Patients with more visits before diagnosis and longer hospitalization time have higher direct economic burden of disease.3.The median direct economic burden of the patients' families was 4,623(3,251,7637)yuan,accounted for 60.81 percent of the direct economic burden of the disease,and the incidence of catastrophic expenditure was 45.92 percent.Low per capita annual income of the family,patients who had long hospitalization time or visited hospitals other than designated hospitals are at greater risk of catastrophic expenditures.4.The median direct financial burden at the diagnosis stage was 1,230(447,3206)yuan;The median direct economic burden at the treatment stage was 7102(5087,12227)yuan,accounting for 8.59%and 91.41%of the direct economic burden of the disease,respectively.5.Among the direct medical expenses,the median direct medical expenses at the treatment stage was 5460(3690,9214)yuan,accounted for 91.32%,The median direct medical expenses for outpatient treatment was 802(544,1283)yuan,and the proportion of medical insurance reimbursement was 9.38%;91.85%of the patients had been hospitalized,and the median direct medical expenses for hospitalization was 4224(2994,8162)yuan,and the proportion of medical insurance reimbursement was 56.70%;the median fee waived by the policy is 315(205,500)yuan,accounted for 4.55%of the direct medical expenses at the treatment stage.patients with long hospitalization time and more CT examinations,Han nationality patients had higher direct medical expenses.Conclusions:1.The direct economic burden of tuberculosis patients' disease is high,and the direct economic burden of the disease is mainly composed of direct medical expenses;Frequent pre-diagnosis visits and long hospital stay are possible risk factors for the high direct economic burden of disease.2.The expenses for policy deduction and medical insurance reimbursement are very limited,the proportion of outpatient reimbursement is very low,the families of tuberculosis patients need to bear most of the direct economic burden of the disease,the families of patients are generally poor,and the incidence of catastrophic expenditure is high.Low income,long hospitalization time,and visited other hospitals in addition to designated hospitals are potentially risk factors for catastrophic expenditures.3.The direct medical expenses of tuberculosis patients were high,and the patients'ethnic group was Han,the long hospitalization time and the number of CT examinations during diagnosis and treatment were the possible risk factors for the high direct medical expenses.4.The direct economic burden in the diagnosis stage was relatively small,and the direct economic burden of the disease mainly occurred in the treatment stage.5.Tuberculosis patients in hospital treatment rate was high,the direct medical cost of hospitalization is much higher than that of outpatient treatment.