Research On Economic Burden Of Disease And Its Determinants Of Tuberculosis Patient In Shandong Province

Tuberculosis is a kind of chronic infections disease caused by mycobacterium tuberculosis. It not only influences the patient's healthy, even to death, but also can infect the people around so as to cause serious public health and social problems. Meanwhile, Tuberculosis is also a disease of poverty; the poorer areas, the more patients. China is one of the 22 most TB burden countries in the world, and the prevalence of tuberculosis ranks second in the world. It is estimated that china's total tuberculosis patients is a quarter of the world, among them, about 85% of tuberculosis patients in the vast rural areas. As a chronic disease, TB has characteristic of longer duration, longer treatment cycle, and the higher cost, what's more, it can decrease patients'social labor production capacity and reduce the social effective labor productivity, so TB not only cause a severe economic burden to the family, but also cause huge economic loss to the whole society. TB has become one of the major diseases which lead to rural poverty, restrain the economic and social development in rural.ObjectiveIn order to understand the economic burden of disease of the tuberculosis patients and its influencing factors from the household perspective, to analyze the effect of various factors in the economic burden of disease of tuberculosis patients, we surveyed the tuberculosis patients in six counties in Shandong Province, so that we can put forward relevant policy suggestions for the prevention and controlling of TB in Shandong Province.The specific objectives of this study are as follows:1. To investigate the basic characteristic and the family economic situation of tuberculosis patients in different areas. 2. To investigate the process of diagnostic and treatment and the related expense and the time loss of the tuberculosis patients.3. To explore the effect on the economic burden of disease of TB patients with different demographic characteristic and economic conditions.4. To explore the effect on the economic burden of disease of TB patients with different diagnosis and treatment.5. To put forward relevant policy suggestions to reduce the TB disease economic burden based on the above results.MethodsObtained the backgrand and calculation methods of TB disease economic burden by literature review method; Sampled randomly six counties of Shandong Province thirty-six towns-ships by stratified-cluster-random sampling method; surveyed all the registered TB patients on October 1 st,2006 to September 30,2007 of each townships using the questionnaire by face-to-face interviews method. SPSS16.0 was used in this research Describe the characteristic of the TB patients such as sex, age, occupations and the family's economic conditions by descriptive analysis; Kruskal- Wallis H test and spearmen-related analysis etal were used for single factor analysis of patients' direct economic burden and indirect economic burden; Logistic regression analysis was used to explore the influencing factors.Main Results1. Among the tuberculosis patients who had been the end of treatment, the economic burden of one patients for 5732.82yuan, median3328.93yuan; among them, the direct economic burden of one TB patients for 5585.85yuan, with a median of 32 OOyuan, the indirect economic burden of one TB patients for 193.73yuan,with a median of 73.17yuan. The proportion of economic burden which accounts for 2007 average yearly income is 65.40%.2. The family economic situation was poorer and family income was lower, but the medical expense was higher among the TB patients. The annual household income was 8765.71yuan. Annual per capita income was 2750.16yuan and the annual expenditure of family medical care was 4484.55yuan. 3. The influencing factors of the disesse economic burden of the TB patients:①The disease economic burden of TB patients existed regional difference. The direct cost of the Taierzhuang TB patients was highest, lowest in Bincheng. The indirect cost of the Jinxiang TB patients was highest, lowest in Bincheng.②Economic status had nothing to do with the total cost of treatment, the lower family income of patients, the weaker ability to pay, but they must bear the same cost, so they should greater disease economic burden relatively.③The doctor's diagnostic capacity has significantly affects on the disease economic burden of TB patients. The longer confirmed diagnosis delay, the more times for diagnosis before confirmed diagnosis, the higher diagnosis unit level, the heavier the patient's disease economic burden.④The economic burden of inpatients is heavier, unnecessary hospital expenses increased the disease economic burden of the TB patients.⑤Logistic analysis results showed that the influencing factors of the direct economic burden of the TB patients were district, confirmed diagnosis unit level, different chemotherapeutical management mode and hospitalization; The influencing factors of the indirect economic burden of the TB patients were district, the first diagnosed unit, the times for diagnosis before confirmed diagnosis and hospitalization.Coclusions1. Further strengthen propaganda of the relevant prevention and controlling of tuberculosis knowledge, to ensure the TB patients can be diagnosed timely and antituberculosis therapy, so as to reduce the unnecessary expense.2. Further increases funding of TB controlling and prevention, increase the scope of preferential, to ensure patients to enjoy free examination and treatment.3. Improves the diagnosis capacity of the basic medical staff, implement centralized management of TB; strengthen TB tertiary prevention network construction; establish and perfect the TB referral system to save medical expensesof the TB patients.4. Strictly regulate the behavior of medical institutions and standard the inclusion criteria of tuberculosis inpatients with medical institutions to reduce unnecessary expense of TB inpatients.5. Establish effective medical security system, and put the tuberculosis into the medical security system such as the new rural cooperative medical scheme, to increase the reimbursement proportion of TB patients.