结核与肺部疾病杂志 ›› 2022, Vol. 3 ›› Issue (6): 469-476.doi: 10.19983/j.issn.2096-8493.20220154

• 论著 • 上一篇    下一篇

云南省三县区肺结核患者灾难性支出调查研究

刘良丽1, 赵誉洁2, 杨云斌1, 陈金瓯1, 许琳1()   

  1. 1.云南省疾病预防控制中心结核病防治所,昆明 650022
    2.昆明市疾病预防控制中心免疫规划科,昆明 650228
  • 收稿日期:2022-09-26 出版日期:2022-12-20 发布日期:2022-12-15
  • 通信作者: 许琳 E-mail:123316859@qq.com
  • 基金资助:
    云南省卫生厅内设研究机构(2018NS0226);云南省高层次卫生计生技术人才培养项目(H-2019027);云南省万人计划名医专项

Investigation on catastrophic cost of pulmonary tuberculosis in three counties, Yunnan Province

Liu Liangli1, Zhao Yujie2, Yang Yunbin1, Chen Jin’ou1, Xu Lin1()   

  1. 1. Institute of Tuberculosis Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming 650022, China
    2. Department of Planned Immunization, Kunming Center for Disease Control and Prevention, Kunming 650228, China
  • Received:2022-09-26 Online:2022-12-20 Published:2022-12-15
  • Contact: Xu Lin E-mail:123316859@qq.com
  • Supported by:
    Yunnan Provincial Department of Health(2018NS0226);Yunnan Health Training Program for High-Level Talents(H-2019027);Yunnan Provincial High-Level Talent Incubator Program

摘要:

目的: 分析云南省三县区肺结核患者灾难性支出发生情况及影响因素,为制定及调整本地区肺结核患者社会保障政策提供参考。方法: 以面对面问卷调查与医院内信息系统查询相结合的方式对2017年以来云南省墨江县、澜沧县、思茅区3个县区完成疗程的233例肺结核患者(达到样本量要求即停止收集)进行回顾性调查,以了解结核病患者灾难性支出(自付总费用超过家庭年收入的20%)发生情况及影响因素。结果: 233例患者例均总支出费用[中位数(四分位数)]为7820(5269,12754)元,其中自付总费用为4623(3251,7637)元,占总支出费用的60.81%。其中,直接医疗自付费用为2705(1727,4559)元,占自付总费用的62.89%;直接非医疗自付费用为1760(822,3192)元,占自付总费用的37.11%。69.53%(162/233)的患者发生了灾难性支出。Logistic回归分析结果显示,家庭人均年收入高(≥4000元)的患者发生灾难性支出的风险低(OR=0.062,95%CI:0.025~0.156),住院次数多(2次及以上)和有多院就诊经历的患者灾难性支出的发生风险高(OR=37.610,95%CI:7.615~185.742;OR=4.196,95%CI:1.457~12.079)。结论: 云南省部分地区肺结核患者发生灾难性支出的情况严峻,进一步加强家庭人均年收入低、住院治疗次数多、有多院就诊经历患者的社会保障措施的制定和完善是非常有必要的。

关键词: 结核,肺, 医疗费用无力承担, 小地区分析

Abstract:

Objective: To investigate the catastrophic costs of pulmonary tuberculosis (PTB) and the influencing factors, in order to provide reference for formulating and improving social security measures for PTB patients in Yunnan Province. Methods: A retrospective investigation was conducted in 233 PTB patients who completed the course of treatment from Mojiang, Lancang and Simao County, Yunnan Province by the way of face-to-face questionnaire and hospital information system query since 2017. The catastrophic costs of PTB patients (account for over 20% of annual income) influencing factors were investigated. Results: A total of 233 patients were included in this survey. The total cost (M(Q1,Q3)) was RMB 7820 (5269, 12754) yuan with the total self paid cost of 4623 (3251, 7637) yuan, which accounted for 60.81% of the total cost. The direct medical cost was RMB 2705 (1727, 4559) yuan, which accounted for 62.89% of the total self paid cost. The indirect medical cost was 1760 (822, 3192) yuan, which accounted for 37.11% of the total self paid cost. Overall, the proportion of patients with catastrophic cost was 69.53% (162/233). The results of binary logistic regression analysis showed that patients with high annual family income (≥RMB 4000 yuan) had low risk of catastrophic expenditure (OR=0.062, 95%CI: 0.025-0.156), and the risk of catastrophic expenditure was high in patients with more than once hospitalization experiences or multi-hospital experiences (OR=37.610, 95%CI: 7.615-185.742; OR=4.196, 95%CI: 1.457-12.079). Conclusion: The situation of PTB patients experienced catastrophic cost is severe in Yunnan Province, thus, it is necessary to strengthen the formulation and improvement of social security measures for patients with low annual family income per capita, more than once hospitalization experiences or multi-hospital experiences.

Key words: Tuberculosis, pulmonary, Medical indigency, Small-area analysis

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