浙江省丽水市耐多药肺结核患者治疗减免政策实施现况分析

Analysis on subsidy policy of multi-drug resistant tuberculosis among patients in Lishui City

目的分析浙江省丽水市耐多药肺结核患者治疗减免政策实施现况。方法对2011—2017年丽水市确诊的耐多药肺结核患者71例进行问卷调查、资料查阅,了解其社会人口学特征、诊疗过程及相关医疗费用支出和减免报销的情况,并采用logistic回归模型分析减免政策对治疗结局的影响。结果 2011—2017年在丽水市确诊的71例耐多药结核病患者共获得219.2万元的费用减免,减免金额和减免比例的中位数分别为29 650.0元和73.7%。经Wilcoxon秩和检验,年龄<53岁的耐多药肺结核患者其减免金额(30650.0元)高于≥53岁年龄组(25 813.0元,Z=-2.654,P=0.008);月收入>2 000元的耐多药肺结核患者其减免金额(30650.0元)高于月收入<2 000元组(22887.5元,Z=-2.479,P=0.013);曾住院的耐多药肺结核患者其减免金额(31650.0元)高于未住院组(29694.5元,Z=-3.403,P=0.001)。多因素logistic回归分析显示,减免金额<29 650元(OR=11.056,95%CI=2.793~43.769,P=0.001)、减免比例<73.7%(OR=4.881,95%CI=1.156~20.606,P=0.031)是耐多药肺结核患者治疗成功的负面影响因素。结论丽水市耐多药肺结核患者治疗减免政策减轻了患者的经济负担,建议持续实施。

Objective To analyze on subsidy policy of multi-drug resistant tuberculosis(MDR-TB) among patients in Lishui City. Methods A total of 71 MDR-TB patients diagnosed from 2011 to 2017 were enrolled and interviewed with a structured questionnaire covering personal information, diagnosis and treatment procedure and relevant cost. And the effect of relief policy on the outcome of treatment was also analyzed by multivariate logistic regression. Results All 71 MDR-TB patients diagnosed during 2011 and 2017 received actual subsidy, and total subsidy amount was 2.192 million RMB. Subsidy per capita was 29 650 RMB and the subsidy proportion median was 73.7%. Subsidy per capita and proportion of MDR-TB patients with age less than 53 years old(30650RMB)was higher than patients with age more than 53 years old(25813RMB, Z=-2.654, P=0.008). Subsidy per capita of MDR-TB patients with monthly income more than 2000RMB(30650RMB)was higher than patients with monthly income less than 2000RMB(22887.5RMB, Z=-2.479, P=0.013).Subsidy per capita of MDR-TB patients who had been hospitalized(31650RMB)was higher than patients in no hospitalized group RMB(29694.5RMB, Z=-3.403, P=0.001).In the multivariate logistic regression analysis, subsidy per capita which was less than 29 650 RMB(OR=11.056, 95% CI: 2.793-43.769, P=0.001) and subsidy proportion less than 73.7%(OR=4.881, 95% CI: 1.156-20.606, P=0.031) were factors negatively affecting success of MDR-TB treatment. Conclusion In Lishui City, the current subsidy policy for MDR-TB patients had fundamentally relieved patients’ economic burden. It is recommended that the implementation be sustained.