河南省贫困地区DOTS策略下肺结核病费用及其影响因素调查  

INVES TIGATION OF THE COST OF PULMONARY TUBERCULOSIS UNDER THE STRATEGY OF DOTS AND ITS INFLUNCING FACTORS IN THE POVERTY-STRICKEN AREA OF HENAN

作　　者：王国杰[1] 马士文[1] 谢春雨[1] 孟澜涛[1] 甄新安[1] 高三友[1] 要玉霞[1] 

机构地区：[1]河南省疾控中心结核病防治研究所,郑州450016

出　　处：《现代预防医学》2007年第7期1236-1239,共4页Modern Preventive Medicine

基　　金：WB/DFID中国结核病控制项目资助;中国结核病实施性研究委员会批准的结核病社会学评价项目的费用部分结果

摘　　要：[目的]了解贫困地区DOTS策略与免费政策下肺结核病的个人支出费用及其影响因素。[方法]兼顾不同地理位置、DOTS执行情况等,采用非概率抽样选择3个贫困县作为调查现场,以这些县结核病防治机构登记并完成治疗的肺结核病人为调查对象,从调查开始日期向后依次入选,每县要求至少入选70例;制定统一的调查表,进行入户调查。[结果]共调查肺结核病人228例,其中190例免费治疗,38例非免费治疗;肺结核病的个人支出费用平均为2 223.6元/例(确诊前、后的支出分别占42.4%、57.6%;医疗支出与非医疗支出分别占87.3%、12.7%),其中免费病人平均为2 050.6元/例,非免费病人平均为3 088.5元/例。采用多因素logistic回归模型分析,与病人确诊前花费较高相关的因素有就诊次数、首次就诊到确诊时间,与病人确诊后花费较高相关的因素有确诊前花费、是否免费治疗、是否曾住院。[结论]河南省贫困地区DOTS策略下免费政策对肺结核病人的经济负担尽管有所减轻,然而免费范围有限,病人1年的收入尚不能满足看病的支出,经济负担是沉重的;病人发病后不能及时确诊、确诊后的一些不必要检查、不必要的昂贵辅助用药、不必要住院治疗等因素增加了病人的经济负担。[Objective] To learn the cost of pulmonary tuberculosis （PTB） under the strategy of DOTS and its influnchag factors in the poverty-stricken area of Henan. [Methods] Three poverty-stricken counties were selected for field survey by non-probability sampling and at least 70 PTB patients who had registered ha each anti-TB institutions of the three counties and had completed the treatment course were required to be forwardly enrolled as the study subjects for household interview with uniform questionnaire from the starting date of the survey in turn. [Results] 228 PTB patients were interviewed, 190 of which were given free treatment. The average cost paid by the patients was 2 223.6 yuan/case, of which the costs before and after PTB diagnosis accounted for 42.4% and 57.6% respectively, and their medical cost and non-medical cost accounted for 87.3% and 12.7% respectively. The average costs paid by the patients with free treatment and without free treatment were 2 050.6 yuan/case and 3 088,5 yuan/case respectively. The analysis results from multivariate logistic regression showed that higher cost paid before PTB diagnosis was significantly associated with consulting times and period from the first consulting date to the date when PTB was diagnosed, while higher cost paid after PTB diagnosis was significantly associated with higher cost before PTB diagnosis, not covered by free treatment policy, experiencing the treatment in hospital. [ Conclusion ] With DOTS and free treatment policy, the economic burden of PIB patients is reduced in the poverty-stricken area of Henan to some extend, but their one-year income still can＇ t meet the costs so the economic burden of PTB is still heavy. The factors such as being unable to get diagnosis correctly, unnecessary test and examination, expensive assistant treatment and hospitalization increase the economic burden of TB patients.

关 键 词：结核 肺 药物治疗 DOTS 费用 

分 类 号：R521[医药卫生—内科学]