上海市闵行区流动人口肺结核病患者直接费用分析  

Analysis on Direct Expense of the Floating Population with/ulmonary Tuberculosis in Minhang District of Shanghai

作　　者：成玉萍[1] 赵黎芳[1] 宫志敏[1] 

机构地区：[1]上海市闵行区疾病预防控制中心,上海201101

出　　处：《中国初级卫生保健》2014年第1期65-67,共3页Chinese Primary Health Care

摘　　要：目的了解上海市闵行区肺结核病患者直接费用现况及减免政策补助比例,为进一步控制结核病医疗费用、完善结核病减免政策提供科学依据。方法收集闵行区5个社区360例结核病患者的就诊信息及各项费用清单,了解患者整个疗程的直接费用,用秩和检验进行单因素分析,了解不同因素对肺结核病患者直接费用的影响,并使用Logistic回归分析排除混杂因素影响。结果肺结核病患者的直接费用、减免补助和减免比例中位数分别为2 670.62元、1 281.85元和46.46%。患者确诊前非定点医疗机构就诊费用中位数为137.00元,患者住院率为7.50%,住院费用中位数为9 001.25元。患者支出费用中其他治疗费用所占比例最高,达27.79%,其次为保肝药(24.86%),而摄片、痰检、肝功能检查和抗痨药物费用仅占35.16%。经Logistic回归分析,是否住院、诊断结果、治疗单位和确诊时间间隔对患者直接费用有显著性影响。结论闵行区肺结核病患者就诊费用相对较低,但住院患者和市级定点医疗机构治疗的患者费用比较明显上升,应逐步规范住院患者和市级医疗机构的诊疗过程。同时,扩大减免项目范围,使患者切实体会到政府的惠民政策,以减少结核病的传播和不规范治疗率。bstract OBJECTIVE To understand direct expense and subsidy proportion of the floating population with pulmonary tuberculosis in Minhang District of Shanghai, so as to provide evidence for controlling the TB medical expense and improving the relief policy. METHODS 360 TB patients＇ medical information and cost inventories were collected in 5 communities, which help to understand the direct expense during the procedure of the treatment. Rank sum test was used to test factors affecting direct expense of TB patients and logistic regression analysis was used to eliminate confounding factors. RESULTS The medians of direct expense, relief subsidies and relief proportion of the TB patients were 2 670.62 yuan , 1 281.85 yuan and 46.46% respectively. The median of medical expenses before the diagnosis of TB was 137.00 yuan in non-designated medical institutions, with 7.50% of the hospitalization rate and median of 9 001.25 yuan for hospitalization cost individually. The highest proportion in the medical cost was the expenses on other treatments, summing to 27.79%, followed by the drugs for liver protection （24.86%）. The total proportions consisted of X-ray, sputum examination, liver function test and anti-tuberculosis drug, occupied 35.16% of the medical expense. The factors affecting medical direct expenses were diagnosis, treatment, hospitalization or not, and time interval to diagnosis. CONCLUSION The average direct expense of patients with TB was lower in Minhang District, while a higher cost for inpatients and outpatients to municipal designated medical institutions was founded. Gradual standardization should be implemented for the process of diagnosis and treatment for inpatients and municipal medical institutions. At the same time, a wider coverage of relief items can help to let the patients experience the government＇s public policy, reduce the spread of tuberculosis and non-standardized treatment.

关 键 词：关键词 肺结核病 流动人口 直接费用 上海 

分 类 号：R521[医药卫生—内科学]