Non-medical financial burden in tuberculosis care: a cross-sectional survey in rural China

Background:Treatment of tuberculosis(TB)in China is partially covered by national programs and health insurance schemes,though TB patients often face considerable medical expenditures.For some,especially those from poorer households,non-medical costs,such as transport,accommodation,and nutritional supplementation may be a substantial additional burden.In this article we aim to evaluate these non-medical costs induced by seeking TB care using data from a large scale cross-sectional survey.Methods:A total of 797 TB cases from three cities were randomly selected using a stratified cluster sampling design.Inpatient medical costs,outpatient medical costs,and direct non-medical costs related to TB treatment were collected using in-person interviews by trained interviewers.Mean and median non-medical costs for different sub-groups were calculated and compared using Kruskal-Wallis and Mann–Whitney U tests.Regression analysis was conducted to assess the influence of different patient characteristics on total non-medical cost.Results:The median non-medical cost was RMB 1429,with interquartile range RMB 424–2793.The median non-medical costs relating to inpatient treatment,outpatient treatment,and additional nutrition supplementation were RMB 540,91,and 900,respectively.Of the 797 cases,20%reported catastrophic expenditure on non-medical costs.Statistically significant differences were detected between different cities,age groups,geographical locations,inpatient/outpatient care,education levels and family income groups.Conclusions:Non-medical costs relating to TB treatment are a serious financial burden for many TB patients.Financial assistance that can limit this burden is urgently needed during the treatment period,especially for the poor.