河南省疟疾防治巩固期费用-完成分析

Cost-performance analysis for consolidating malaria control in Henan Province

目的 :对河南省疟疾防治工作进行费用—完成分析 ,从经济学的角度评价低度流行区疟疾防治工作各项措施的质量和有效性。协助有关部门更科学地制定今后的疟疾防治方案。方法 :于 1994～ 1995年内通过填表和委托乡村医生对来诊的疑似疟疾病人访问填表的形式 ,在疟疾流行的固始、商城两县收集政府和社区用于疟防开支的原始资料 ,回顾性调查每位疑似疟疾病人的治疗费用。对所收集资料进行费用—完成分析。结果 :调查 6个乡镇 ,收集两年内疑似疟疾病人 12 32 5例。每例病人的费用平均为 2 7 85元 ,相当于当地一个农民 10天的收入 ;而政府用于每例病人的费用平均为 4 86元。河南省每年用于疟疾防治的经费总投入约为 6 94434元。在 12 ,32 5例疑似疟疾病人中仅有 2 7% (336 /12 ,32 5 )得到很好的管理 ,34 9% (42 96 /12 ,32 5 )只能得到一般的医疗管理 ,而近三分之二 (6 2 4% )的病人 (76 93/12 ,32 5 )得不到管理。结论 :疟疾防治的费用主要由疑似病人及其家庭支出 ,如果政府经费投入削减 ,将进一步增加病人的负担 ,使其延误治疗 。

Objective: To gather evidence for health policy reform, and assist with strategic design of future malaria control within the health sector, we conducted a prospective study of the costs and performance of Henan's malaria control programme. Methods: We measured the quality and efficiency of suspected malaria case management, the only personal health service component and the most expensive of the 3 products in the Henan programme. We also costed the other two (non personal) components vector and blood surveillance. We collected all government costs at every level, enlisted private health care providers 260 village doctors in 6 rural administrative townships, and studied all 12,325 suspected malaria cases in 1994 and 1995. Results: From the patient perspective, the average cost of treatment for suspected malaria was 27.85 yuan(US$3.38),equivalent to 10 days' income for local peasants. By comparision, each case managed cost the government an average of 4.86 yuan(US$0.61).For the whole of Henan province, the average annual government input into the malaria control programme was estimated at 694,434 yuan (US$84,804). Of the 12,325 suspected malaria cases, only 1.1% (131/12,325) received excellent case management, 36%(4414/12,325) were managed in a mediocre manner and nearly two thirds or 63% (7780/12,325) were inadequately managed. Conclusion: We note that the cost of malaria control is now largely borne by suspected cases and their families. Further decrease in the government allocation will increase this burden and patients may delay treatment, with a concomitant risk of recrudescent transmission and ultimate breakdown of control. We advocate that strenous efforts should be made to improve the efficiency of case management if malaria eradication is to be achieved within Henan, and that good stewardship also requires continued government investment in malaria control at the current levels.