上海市肺结核患者直接医疗费用及经济负担分析

目的 了解上海市肺结核患者确诊及治疗过程的直接医疗费用及其对家庭造成的经济负担，为进一步完善肺结核减免政策，控制肺结核医疗费用，减轻患者负担提供依据。 方法 对上海市松江、杨浦、徐汇、长宁、普陀、浦东新区和闵行7个区共491例完成治疗的肺结核患者进行定量问卷调查，主要了解肺结核患者的社会经济情况、确诊及治疗过程的各项直接医疗费用等。用秩和检验方法对不同类型肺结核患者的各项费用及相应减免比例、各项费用占家庭年人均纯收入比例等进行分析。 结果 肺结核患者的直接医疗总费用及相应减免比例的中位数（上下四分位数）分别为4000(2500,10 500)元/人次、54.9%(32.3%,70.0%)，有34.4%（169/491）的患者发生过住院费用，全程门诊治疗患者和曾经住院治疗患者的直接医疗总费用的中位数（上下四分位数）分别为3000(2000,4000)元/人次、14 955(9200,21 705)元/人次，两者差异有统计学意义（Z=-16.059, P=0.000）。涂阳患者和涂阴患者的直接医疗总费用减免比例的中位数（上下四分位数）分别为57.1%(40.0%,71.5%)、52.1%(25.0%,69.2%)，两者差异有统计学意义（Z=-2.092, P=0.036）。全程门诊治疗患者与曾经住院治疗患者的自付医疗费用占家庭年人均纯收入比例的中位数（四分位数范围）分别为9.4%(3.8%,18.0%)、29.5%(14.8%,89.2%)，两者差异有统计学意义（Z=-7.463, P=0.000）。 结论 上海市肺结核患者确诊及治疗过程的直接医疗费用相对较高，给患者家庭造成了较重的经济负担。

Analysis on direct medical expenses and its financial burden of pulmonary tuberculosis patients in Shanghai

Objective To understand the direct medical expense for diagnosis and treatment of pulmonary tuberculosis(PTB) patients and its financial burden on family in Shanghai,and to provide evidence for improving TB derating policy.Methods Seven districts in Shanghai were selected,and 491 pulmonary TB patients who had completed treatment were investigated by questionnaire.Information about the social economic conditions and direct medical expenses was collected.Ranksum test was used for analysis of patients’ social economic conditions and me-dical expenses.Results The medians(inter-quartile range) of TB patients’ total direct medical expenses and the derating proportion were 4000(2500,10 500) yuan/person and 54.9%(32.3%,70.0%) respectively.34.4% of patients(169/491) had been hospitalized.There was significant difference between total direct medical expenses of outpatients and once-hospitalized patients(Z=-16.059,P=0.000),the medians(inter-quartile range) of which were 3000(2000,4000) yuan/person and 14 955(9200,21 705) yuan/person respectively.The derating proportion of the total direct medical expenses in smear-positive patients was higher than that in smear-negative patients(Z=-2.092,P=0.036),the medians(inter-quartile range) of which were 57.1%(40.0%,71.5%) and 52.1%(25.0%,69.2%) respectively.There was significant difference between the ratio of out-of-pocket medical fee to family net per-capita income in outpatients and once-hospitalized patients(Z=-7.463,P=0.000),the medians(inter-quartile range) of which were 9.4%(3.8%,18.0%) and 29.5%(14.8%,89.2%) respectively.Conclusion The diagnosis and treatment expenses of TB patients in Shanghai were relatively high,which resulted in a heavier financial burden to the patient’s family.