非户籍人口新发肺结核患者家庭灾难性卫生支出现状分析

目的]了解上海市普陀区非户籍人口新发肺结核患者家庭灾难性卫生支出的发生情况,为完善政策体系,提高患者治疗依从性提供参考。方法]对2008年普陀区新登记并完成治疗的初治非户籍人口结核病患者97例开展问卷调查,并结合病史和报表等资料收集患者个人及家庭基本情况和治疗相关信息。结果]经政府减免报销后,以患者支付的直接医疗费用、直接费用和总费用计算,占家庭支付能力的比例分别从11.02%、15.60%和23.06%下降至4.97%、6.13%和12.27%,灾难性卫生支出的发生率从15.46%、23.71%和34.02%下降至8.25%、15.46%和25.77%,灾难性卫生支出平均差距从10.12%、15.03%和24.76%缩小为8.23%、12.28%和21.33%,相对差距从65.47%、63.39%和72.79%缩小为53.20%、51.78%和62.70%。结论]罹患肺结核对普陀区大部分非户籍人口患者家庭尚未造成灾难性影响,但是仍有部分脆弱家庭值得关注。应积极探索综合的保障措施和有效的经济补助形式,切实降低治疗相关费用,从而保护患者家庭免于发生疾病经济风险。

Catastrophic health expenditure among migrants with tuberculosis in Putuo District, Shanghai

Objective] To study catastrophic health expenditure among migrants with tuberculosis for completion of policy system and improvement of patient compliance with treatment in Putuo District, Shanghai. Methods] A retrospective study was conducted to acquire the information about the newly registered domestic migrant patients with completed treatment in 2008 and their family situation that resulted from tuberculosis treatment. Results] For the 97 patients included, the proportions of direct medical cost, direct cost and total cost for tuberculosis treatment to patients＇ capacity to pay were 11.02%, 15.60% and 23.06% while they fell to 4.97%, 6.13% and 12.27% due to the relief policy of the govermnent. There were 15.46%, 23.71% and 34.02% families of target patients that encountered catastrophic health expenditure because of direct medical cost, direct cost and total cost for tuberculosis treat- ment and the proportions were reduced to 8.25%, 15.46% and 25.77% with the help of the relief policy. The mean catastrophic expenditure gaps were reduced from 10.12% , 15.03% and 24.76% to 8.23% , 12.28% and 21. 33% respectively, and the mean positive gap were from 65.47%, 63.39% and 72.79% down to 53.20%, 51.78% and 62.70% owing to the policy. Conclusion] There were not many target families found to have suffered from catastrophic effect caused by tuberculosis treatment but some families still should be concerned about in this regard . Better relief policy should be explored to protect the families from economic risk of the disease.