上海市闵行区肺结核患者直接医疗费用及减免服务包扩展分析

Analysis on direct medical expenses and relief items service package of pulmonary tuberculosis patients in Minhang District of Shanghai

目的了解上海市闵行区肺结核患者确诊及治疗过程中的直接医疗费用及其对家庭造成的经济负担,为进一步完善肺结核减免政策,控制结核病医疗费用,减轻患者的经济负担提供依据。方法对本区347例完成治疗的肺结核患者进行发票的收集以及基本信息的问卷调查。用秩和检验分析不同类型肺结核患者的直接医疗费用;用多元线性回归分析直接医疗费用的影响因素;采用多个率的χ~2检验分析高额医疗费用与年龄、居民年人均可支配收入的关系。结果肺结核患者的直接医疗总费用为5 657元/人次。多元线性回归分析显示,直接医疗费用的影响因素有户籍、主要就诊机构以及有无合并症,其中主要就诊机构(β'=-0.217)对直接医疗费用影响较大。医疗费用扣除医保报销和结核病控制项目减免之后仍然有7.5%的患者产生高额医疗费用,并且在低收入人群中分布较多。结论肺结核确诊及治疗过程的直接医疗费用较高,给患者家庭造成了较严重的经济负担,应加强对老年、有合并症以及贫困群体的肺结核患者的医保报销和减免政策。

Objective To investigte the direct medical expense for diagnosis and treatment of pulmonary tuberculosis（TB）patients and its financial burden on family in Minhang District,Shanghai,and to provide evidence for improving TB derating policy and reducing the economic burden. Methods A total of 347 pulmonary TB patients who had completed treatment were investigated by questionnaire.Their receipts on diagnosis and treatment of TB were collected.Ranksum test,linear regression and χ~2 test were used to analyze medical expenses,influencing factors and social economic burden. Results The median of TB patients＇ direct medical expenses was 5 657 yuan/person.Linear regression showed that direct medical expenses were related with census,main medical institutions and complications.The main medical institutions have a greater impact on direct medical expenses（β＇=-0.217）.In the patients,7.5% had high medical expenditures after the deduction of medical reimbursement and derating.And they were mainly distributed among low-income people. Conclusions The diagnosis and treatment expenses of TB patients were relatively high,which resulted in a heavier financial burden to the patient＇s family.The elderly tuberculosis patients,patients with complications and poor groups should become the focus of medical reimbursement and derating policy.