山东省初治肺结核患者直接费用及疾病经济负担分析

目的了解山东省初治肺结核患者全疗程直接医疗费用与直接非医疗费用及其对家庭造成的经济负担,为进一步控制结核病费用、完善结核病医疗保险政策提供依据。方法采用分层二阶段整群抽样方法,抽取10个县在2013年4月1日—2014年3月31日期间新诊断登记的初治肺结核患者910例,患者疗程结束后使用统一设计的调查问卷进行面对面询问式调查并查询医院医疗保险结算系统,调查患者的相关费用。结果初治肺结核患者直接费用、直接医疗费用、直接非医疗费用医保报销减免前例均分别为(6825.6±9002.2)元、(5490.2±8274.7)元、(1335.4±1978.5)元,M(P25,P75)分别为3636.0(2239.0,8390.0)元、2515.0(1215.0,6515.0)元、842.0(185.0,1880.0)元。医保报销减免后直接费用、直接医疗费用例均分别为(4456.1±8545.7)元、(3120.7±8004.8)元,M(P25,P75)分别为2660.0(1490.0,4804.0)元、1300.0(645.0,3000.0)元。报销减免前后直接费用、直接医疗费用差异有统计学意义(Z=-9.233,-12.623,P<0.001)。药品费(除保肝药和免费一线抗结核药外)在直接医疗费用中占比最高为50.7%,其次是保肝药品费占24.5%。营养费占直接非医疗费用的比例达81.6%。患者医疗费用报销比例为38.5%,中位数仅为6.3%,其中报销比例最高为商业医保。疾病负担系数中位数医保报销前后分别为12.3%和8.6%,发生灾难性卫生支出的患者分别占38.4%和26.8%。医保报销前后发生灾难性卫生支出的患者数差异有统计学意义(χ2=27.577,P<0.001)。结论初治肺结核患者全疗程的直接费用较高,给患者家庭造成了灾难性卫生支出。应进一步提高医保报销比例,合理控制保肝药和辅助抗结核药品的使用,增加营养补助费。

Direct costs and economic burden of pulmonary tuberculosis patients for initial treatment in Shandong

Objective To investigate the direct costs and the family economic burden of pulmonary tuberculosis (TB) patients for initial treatment at the full course of treatment in Shandong, and to provide evidence for improving TB medical insurance policy and reducing the economic burden. Methods A total of 910 pulmonary TB patients, who newly diagnosed in 10 counties during April 1st, 2013 to March 31st, 2014, were selected and applied the two-stage stratified systematic random sampling method. The survey was conducted by face-to-face inquiry at the end of the standard treatment. The information about the social economic conditions and related costs were collected through investigation and medical insurance settlement system. Results Before medical reimbursement and derating, the means and M (P ₂₅,P ₇₅)of direct costs, direct medical costs and direct non-medical costs for new TB patients were(6 825.6±9 002.2)yuan、3 636.0(2 239.0,8 390.0)yuan,(5 490.2± 8 274.7)yuan、2 515.0(1 215.0,6 515.0)yuan and 1 335.4±1978.5)yuan、842.0(185.0,1 880.0)yuan, respectively. After medical reimbursement and derating, the means and M (P ₂₅,P ₇₅) of direct costs, direct medical costs were(4 456.1±8 545.7)yuan、2 660.0(1 490.0,4 804.0)yuan and(3 120.7±8004.8)yuan、1 300.0(645.0,3 000.0)yuan, respectively. There were significant differences before and after medical reimbursement in direct costs and direct medical costs (Z =-9.233, -12.623, P <0.001). The highest proportion in direct medical costs was the drug costs (except the drugs for liver protection) summing to 50.7%, followed by the drugs for liver protection summing to 24.5%. The highest proportion in direct non-medical costs was the nutrition costs summing to 81.6%. The proportion of reimbursement of TB patients was 38.5% and the median was only 6.3%. The highest proportion of reimbursement was the commercial medical insurance. The medians of disease burden were 12.3% and 8.6% respectively, and 38.4% and 26.8% of TB patients had catastrophic health expenditures respectively before and after medical reimbursement and derating. There was a significant difference in the number of TB patients with catastrophic health expenditures before and after medical insurance reimbursement (χ ²=27.577, P< 0.001). Conclusion The direct costs of the whole course of treatment for new TB patients were relatively high, which resulted in catastrophic health expenditures to their families. It is necessary to increase the proportion of medical reimbursement and derating policy, reasonably control the use of liver protecting drugs and second-line anti-tuberculosis drugs, and increase the nutrition subsidies of TB patients.