BACKGROUND:Despite the availability of free tuberculosis (TB) diagnosis and treatment, TB care still generates substantial costs that push people into poverty. We investigated out-of-pocket (OOP) payments for TB care and assessed the resulting economic burden and economic consequences for those with varying levels of household income in eastern China. METHODS:A cross-sectional study was conducted among TB patients in the national TB programme networks in eastern China. TB-related direct OOP costs, time loss, and coping strategies were investigated across households in different economic strata. Analysis of Variance was used to examine the differences in various costs, and Kruskal-Wallis tests were used to compare the difference in total costs as a percentage of annual household income. RESULTS:Among 435 patients, the mean OOP total costs of TB care were USD 2389.5. In the lower-income quartile, OOP payments were lower, but costs as a percentage of reported annual household income were higher. Medical costs and costs prior to treatment accounted for 66.4 and 48.9% of the total costs, respectively. The lower the household income was, the higher the proportion of medical costs to total costs before TB treatment, but the lower the proportion of medical costs patients spent in the intensive phase. TB care caused 25.8% of TB-affected households to fall below the poverty line and caused the poverty gap (PG) to increase by United States Dollar (USD) 145.6. Patients in the poorest households had the highest poverty headcount ratio (70.2%) and PG (USD 236.1), but those in moderately poor households had the largest increase in the poverty headcount ratio (36.2%) and PG (USD 177.8) due to TB care. Patients from poor households were more likely to borrow money to cope with the costs of TB care; however, there were fewer social consequences, except for food insecurity, in poor households. CONCLUSIONS:Medical and pretreatment costs lead to high costs of TB care, especially among patients from the poorest households. It is necessary to train health system staff in general hospitals to promptly identify and refer TB patients. Pro-poor programmes are also needed to protect TB patients from the medical poverty trap.

译文

背景:尽管有免费的结核病(TB)诊断和治疗方法,但结核病护理仍然产生大量的费用,使人们陷入贫困。我们调查了结核病护理的自付费用(OOP),并评估了中国东部家庭收入水平各异的人群所承受的经济负担和经济后果。
方法:在中国东部国家结核病规划网络中对结核病患者进行了横断面研究。在不同经济阶层的家庭中调查了与结核相关的直接OOP成本,时间损失和应对策略。方差分析用于检查各种成本的差异,而Kruskal-Wallis检验用于比较总成本在家庭年收入中所占百分比的差异。
结果:在435名患者中,结核病护理的平均OOP总费用为2389.5美元。在收入较低的四分位数中,OOP支付额较低,但成本占报告的家庭年收入的百分比较高。医疗费用和治疗前费用分别占总费用的66.4%和48.9%。家庭收入越低,结核病治疗前的医疗费用在总费用中所占的比例就越高,但在强化治疗阶段花费在患者身上的医疗费用所占的比例就越低。结核病护理使25.8%的受结核病影响的家庭降至贫困线以下,并使贫困差距(PG)增加了145.6美元。最贫困家庭的患者的贫困率最高(70.2%)和PG(236.1美元),而中度贫困家庭的患者由于结核病,贫困率最高(36.2%)和PG(177.8美元)关心。来自贫困家庭的患者更有可能借钱来应付结核病护理费用;但是,除了粮食不安全以外,贫困家庭的社会后果较少。
结论:医疗和预处理费用导致结核病护理的高昂费用,尤其是在最贫困家庭的患者中。有必要对综合医院的卫生系统人员进行培训,以迅速发现并转诊结核病患者。还需要扶贫计划,以保护结核病患者免受医疗贫困陷阱的困扰。

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