Analysis On The Structure Variation And The Influencing Factors Of Drug-resistant Tuberculosis Patients Hospitalization Expenses In Xinjiang

Objective:To understand the changes and influencing factors of hospitalization expenses of drug-resistant pulmonary tuberculosis patients in Xinjiang from 2013 to2017;To provide scientific reference for reducing the medical expenses of drug-resistant pulmonary tuberculosis and improving the prevention and control policies and measures of drug-resistant pulmonary tuberculosis.Methods:The hospitalization expenses of drug-resistant pulmonary tuberculosis inpatients in chest hospital of Xinjiang Uygur autonomous region from 2013 to 2017 were studied.Results:A total of 3226 cases of drug-resistant pulmonary tuberculosis were collected from 2013-2017in thoracic hospital of the autonomous region,of which males were more than females.The mean age was47.29±17.597;Average length of stay 18d?median?.The type of patient medical insurance is mostly new rural cooperative medical system.More than half of the patients did not undergo surgery,and the majority of patients with different drug resistance types were multidrug resistant.Between 2013 and 2017,the average number of inpatients with drug-resistant pulmonary tuberculosis increased year by year.The per capita hospitalization expenses of MDR-TB patients were the highest among different types of drug-resistant TB patients.In terms of the change trend of each cost in the past five years,the per capita cost of western medicine is the highest,showing an upward trend.Other projects are in a state of fluctuation over the past five years,the change is small.In2013-2017,the proportion of expenses of inpatients with drug-resistant pulmonary tuberculosis was relatively stable,with western medicine accounting for the highest proportion,followed by laboratory fees,while bed fees,traditional Chinese medicine fees,nursing fees,examination fees,treatment fees,examination fees,other fees and materials accounted for a relatively low proportion.In 2013-2017,the cost structure of inpatients with drug-resistant pulmonary tuberculosis changed slowly,and 2015-2016 was the most severe period.The cost of western medicine is only positive overall change,other costs are negative changes.The univariate analysis of the influencing factors of hospitalization expenses of drug-resistant pulmonary tuberculosis patients showed that the difference of hospitalization expenses in age,different medical insurance types,the nature of residence,different drug-resistant types,actual hospital days,surgery,proportion of western medicine and other seven factors was statistically significant,but the difference of gender,education level,nationality,occupation and other factors was not statistically significant.Comparing the hospitalization expenses of patients with newly treated drug-resistant pulmonary tuberculosis and patients with newly treated non-drug-resistant pulmonary tuberculosis in thoracic hospital in 2017,it was found that the per capita total hospitalization expenses,western medicine fees,laboratory fees,treatment fees,examination fees,diagnosis fees,nursing fees,material costs and other expenses of the two groups were significantly different.the per capita expenses of patients with newly treated drug-resistant group were higher than those of patients with newly treated sensitive group.Multivariate analysis of hospitalization expenses of drug-resistant pulmonary tuberculosis patients showed that the main factors affecting hospitalization expenses of pulmonary tuberculosis patients were:proportion of western medicine,number of days in hospital,type of medical insurance payment,operation status and drug-resistant type.The complete multiple linear regression equation of hospitalization expenses can be obtained by non-standardized coefficient b:y=8.632+0.202_x1+0.368_x2+0.274_x3-0.011_x4+0.238_X5+0.119_x6-0.039_x7.Conclusion:1)The age of drug-resistant pulmonary tuberculosis patients is concentrated in young and middle-aged people,which brings burden to society and family;2)during the past ten years,the per capita hospitalization expenses of drug-resistant pulmonary tuberculosis patients showed an upward trend,the expenses also increased significantly,and the economic burden of drug-resistant pulmonary tuberculosis patients increased;3)western medicine fees and laboratory fees accounted for the proportion of the total medical expenses is higher,and treatment fees,nursing fees,operation fees and other technical expenses accounted for a lower proportion;Drug cost is the main factor leading to the increase of hospitalization cost structure.4)the main factors affecting the hospitalization expenses of drug-resistant pulmonary tuberculosis patients are:operation,proportion of western medicine,actual hospitalization days,medical insurance category,drug-resistant type,age and the nature of residence.