Utilization and expenses of outpatient services among tuberculosis patients in three Chinese counties:an observational comparison study  

作　　者：Xuan-Xuan Wang Jia-Ying Chen Hui Jiang An-Na Zhu Qian Long John SJi 

机构地区：[1]School of Health Policy and Management,Nanjing Medical University,No.101 Longmian Avenue,Nanjing 211166,Jiangsu Province,China [2]Center for Health Policy Studies,Nanjing Medical University,No.101 Longmian Avenue,Nanjing 211166,Jiangsu Province,China [3]Creative Health Policy Research Group,Nanjing Medical University,No.101 Longmian Avenue,Nanjing 211166,Jiangsu Province,China [4]Zhenjiang Center for Disease Control and Prevention,No.9 Huangshan South Road,Zhenjiang 212004,Jiangsu Province,China [5]Environmental Research Center,Duke Kunshan University,No.8 Duke Avenue,Kunshan 215316,Jiangsu Province,China [6]Global Health Research Center,Duke Kunshan University,No.8 Duke Avenue,Kunshan 215316,Jiangsu Province,China [7]Nicholas School of the Environment,Duke University,Durham,NC 27708,USA

出　　处：《Infectious Diseases of Poverty》2019年第5期40-51,共12页贫困所致传染病（英文）

基　　金：The study is part of the program entitled

摘　　要：Background:The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014,designed specifically for patients diagnosed with Tuberculosis(TB).This study aimed to examine the changes in utilization and expenses of outpatient services before and after the reform implementation,among TB patients in the three counties in China.Methods:We collected quantitative data using surveys in 2013(baseline year)and 2015(final year).We used outpatient hospital records to measure service utilization and medical expenses of TB patients.We conducted qualitative interviews with local health authorities,officers of health insurance agencies,and hospital managers(n=18).We utilized three focus group discussions with hospital staff and TB doctors and nurses.The x^2 tests and Mann-Whitney U tests were used to analyse quantitative data,and the thematic analysis using a framework approach was applied to analyse qualitative data.Results:Dantu and Yangzhong counties enacted TB-specific case-based payment method in 2014.Jurong County maintained global budget payment but raised the reimbursement rate for TB care.Compared to the baseline,the percentage of TB patients in Dantu and Yangzhong with eight or above outpatient visits increased from 7.5 to 55.1%and from 22.1 to 53.1%in the final survey,respectively.Jurong experienced the opposite trend,decreasing from 63.0 to 9.8%.In the final survey,the total outpatient expenses per patient during a full treatment course in Dantu(RMB 2939.7)and Yangzhong(RMB 2520.6)were significantly higher than those in the baseline(RMB 690.4 and RMB 1001.5,respectively),while the total outpatient expenses in Jurong decreased significantly(RMB 1976.0 in the baseline and RMB 660.8 in the final survey).Health insurance agencies in Dantu and Yangzhong did not approve the original design with outpatient and inpatient expenses packaged together,revealed by qualitative interviews.Furthermore,staff at designated hospitals misunderstood that health insurance agencies would only rei

关 键 词：TUBERCULOSIS Outpatient care expenses Outpatient services Case-based payment Global budget payment 

分 类 号：F42[经济管理—产业经济]