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Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China

查看全文 作　　者：Chengchao [1]Zhou;Qian [2,3]Long;Jiaying [4]Chen;Li [5]Xiang;Qiang [6]Li;Shenglan [2,3]Tang;Fei [7]Huang;Qiang [8,9]Sun;Henry [10]Lucas 高影响力作者 机构地区：[1]Department of Health Service Management and Maternal and Child Health,School of Public Health,Shandong University,Jinan,China;[2]Duke Global Health Institute,Duke University,Durham,NC,USA;[3]Global Health Research Center,Duke Kunshan University,Kunshan,China;[4]School of Health Policy and Management,Nanjing Medical University,Nanjing,China;[5]School of Medicine and Health Management,Huazhong University of Science and Technology,Wuhan,China;[6]School of Public Health,Xi’an Jiaotong University,Xi’an,China;[7]National Center for TB Control and Prevention,China CDC,Beijing,China;[8]Center for Health Management and Policy,Shandong University,Wen-hua-xi Road No.44,Jinan City 250012,China;[9]Key Lab of Health Economic and Policy Studies of Ministry of Health,Jinan,China;[10]Institute of Development Studies,Sussex University,Brighton,UK高影响力机构 出　　处：《Infectious Diseases of Poverty》索引2016年第5卷第1期,共10页高影响力期刊 基　　金：The study upon which this paper was written is part of the large program entitled“China National Health and Family Planning Commission and the Gates Foundation TB Project”-a collaboration between the Government of China and the Melinda and Bill Gates Foundation(Grant No.51914);implemented by the China Center of Disease Control and Prevention(CDC)。 摘　　要：Background:Tuberculosis(TB)often causes catastrophic economic effects on both the individual suffering the disease and their households.A number of studies have analyzed patient and household expenditure on TB care,but there does not appear to be any that have assessed the incidence,intensity and determinants of catastrophic health expenditure(CHE)relating to TB care in China.That will be the objective of this paper.Methods:The data used for this study were derived from the baseline survey of the China Government–Gates Foundation TB Phase Ⅱ program.Our analysis included 747 TB cases.Catastrophic health expenditure for TB care was estimated using two approaches,with households defined as experiencing CHE if their annual expenditure on TB care:(a)exceeded 10%of total household income;and(b)exceeded 40%of their non-food expenditure(capacity to pay).Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE.Results:The incidence of CHE was 66.8%using the household income measure and 54.7%using non-food expenditure(capacity to pay).An inverse association was observed between CHE rates and household income level.Significant determinants of CHE were:age,household size,employment status,health insurance status,patient income as a percentage of total household income,hospitalization and status as a minimum living security household.Factors including gender,marital status and type of TB case had no significant associations with CHE.Conclusions:Catastrophic health expenditure incidence from TB care is high in China.An integrated policy expanding the free treatment package and ensuring universal coverage,especially the height of UHC for TB patients,is needed.Financial and social protection interventions are essential for identified at-risk groups. 关 键 词：Catastrophic health expenditure TUBERCULOSIS Determinants China
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