Background:Tuberculosis(TB)patients in China encounter heavy financial burdens throughout the course of their treatment and it is unclear how China’s health insurance systems affect the alleviation of this burden und...Background:Tuberculosis(TB)patients in China encounter heavy financial burdens throughout the course of their treatment and it is unclear how China’s health insurance systems affect the alleviation of this burden under the integrated approach.This study aimed to measure reimbursement for TB services under the New Cooperative Medical Scheme(NCMS)in rural China and to evaluate changes in catastrophic health expenditure(CHE)caused by the reimbursement policies.Methods:Reimbursement data were obtained from routine data systems for the NCMS in Yichang(YC)and Hanzhong(HZ).1884 TB inpatients reimbursed by NCMS from 2010 to 2012 were included.Household surveys were conducted.A total of 494 TB patients under the NCMS were selected in this paper.12 Focus Group Discussions(FGDs)were held.We measured the impact of the NCMS by counterfactual analysis,which analyzed the financial burden alleviation.Equity was assessed by Concentration Index(CI),and disaggregated by project sites.Results:TB inpatients were reimbursed with an effective reimbursement rate of 57.3%.Average out-of-pocket(OOP)payments for outpatient and inpatient services after diagnosis were 1413 yuan and 430 yuan,and 3572 yuan and 3013 yuan in YC and HZ,respectively.The reimbursement level for TB outpatient care after diagnosis was very low due to a limited outpatient quota.TB patients in HZ incurred higher effective reimbursement rates,but the incidence of CHE remained higher.The reduction of CHE incidence after the NCMS showed no difference statistically(P>0.05).The severity of CHE was alleviated slightly.CIs after reimbursement were all below zero and their absolute values were higher than those before reimbursement.Conclusions:Low reimbursement for TB patients could lead to heavy financial burden.Poor TB patients incurred high rates of CHE.The NCMS was found to be a protective factor for CHE,but the impact was modest and the equity of CHE did not improve.The NCMS reimbursement policies should be improved in the future to include a more comprehensive coverage of care.Supplemental programs may be necessary to expand coverage for TB care.展开更多
What is already known about this topic?Multidrug-resistant tuberculosis(MDR-TB)is a type of tuberculosis with resistance to common treatments such as isoniazid and rifampicin.MDR-TB is a major global health challenge ...What is already known about this topic?Multidrug-resistant tuberculosis(MDR-TB)is a type of tuberculosis with resistance to common treatments such as isoniazid and rifampicin.MDR-TB is a major global health challenge and needs to be controlled tightly through prevention measures,early diagnosis,and full treatment and management.What is added by this report?This outbreak was the first MDR-TB related public health emergency in Hubei Province.In total,five MDR-TB cases and nine clinically diagnosed cases were identified within one class in a secondary school.Students and teachers from other classes were monitored,but no other cases were found.What are the implications for public health practice?The implementation of TB prevention and control measures in schools is important to increase knowledge on TB and to raise awareness on protecting personal wellbeing.The Automatic Early Warning Information System alerted the local health department and allowed for a timely response to prevent further disease spread.展开更多
Summary What is already known about topic?Multidrug-resistant tuberculosis(MDR-TB)has become a growing threat to public health.There were few reports about family-to-school MDR-TB outbreaks in China,especially during ...Summary What is already known about topic?Multidrug-resistant tuberculosis(MDR-TB)has become a growing threat to public health.There were few reports about family-to-school MDR-TB outbreaks in China,especially during the coronavirus disease 2019(COVID-19)pandemic.What is added by this report?A tuberculosis(TB)outbreak happened in Hubei Province during the COVID-19 pandemic.The transmission chain was probably from a father(MDRTB case)with retreated TB history to his daughter,who then spread TB to her classmates.展开更多
Summary What is already known about this topic?The association of diabetes mellitus(DM)with both increased risk of tuberculosis(TB)and unfavorable treatment outcomes has been identified by many studies(1).However,epid...Summary What is already known about this topic?The association of diabetes mellitus(DM)with both increased risk of tuberculosis(TB)and unfavorable treatment outcomes has been identified by many studies(1).However,epidemic data for TB cases in DM patients is absent in China.What is added by this report?This current population-based prospective cohort study,conducted in ten counties located in eastern,central,and western China during 2013–2015,revealed a high prevalence and incidence of TB in known DM patients.Most TB cases were captured by active case-finding and a much higher presence of being asymptomatic among TB/DM patients was obtained.What are the implications for public health practice?Active case-finding should be carried out in DM patients and populations at high risk for developing TB.A TB symptom screening-based case-finding strategy is not enough;chest radiography check should be done once a year for these patients.展开更多
基金supported by the project“Research on Economic Risk of Major Diseases and the Protection Effect Model of Rural Residents in the Central and Western Regions of China”(Grant No.71203068)the“Study on the Dynamic Optimization of Catastrophic Health Insurance Reimbursement Modes and the Scale of Fund Expenditure in the Perspective of UHC”(Grant No.71573095)supported by the National Natural Science Foundation of China.
文摘Background:Tuberculosis(TB)patients in China encounter heavy financial burdens throughout the course of their treatment and it is unclear how China’s health insurance systems affect the alleviation of this burden under the integrated approach.This study aimed to measure reimbursement for TB services under the New Cooperative Medical Scheme(NCMS)in rural China and to evaluate changes in catastrophic health expenditure(CHE)caused by the reimbursement policies.Methods:Reimbursement data were obtained from routine data systems for the NCMS in Yichang(YC)and Hanzhong(HZ).1884 TB inpatients reimbursed by NCMS from 2010 to 2012 were included.Household surveys were conducted.A total of 494 TB patients under the NCMS were selected in this paper.12 Focus Group Discussions(FGDs)were held.We measured the impact of the NCMS by counterfactual analysis,which analyzed the financial burden alleviation.Equity was assessed by Concentration Index(CI),and disaggregated by project sites.Results:TB inpatients were reimbursed with an effective reimbursement rate of 57.3%.Average out-of-pocket(OOP)payments for outpatient and inpatient services after diagnosis were 1413 yuan and 430 yuan,and 3572 yuan and 3013 yuan in YC and HZ,respectively.The reimbursement level for TB outpatient care after diagnosis was very low due to a limited outpatient quota.TB patients in HZ incurred higher effective reimbursement rates,but the incidence of CHE remained higher.The reduction of CHE incidence after the NCMS showed no difference statistically(P>0.05).The severity of CHE was alleviated slightly.CIs after reimbursement were all below zero and their absolute values were higher than those before reimbursement.Conclusions:Low reimbursement for TB patients could lead to heavy financial burden.Poor TB patients incurred high rates of CHE.The NCMS was found to be a protective factor for CHE,but the impact was modest and the equity of CHE did not improve.The NCMS reimbursement policies should be improved in the future to include a more comprehensive coverage of care.Supplemental programs may be necessary to expand coverage for TB care.
文摘What is already known about this topic?Multidrug-resistant tuberculosis(MDR-TB)is a type of tuberculosis with resistance to common treatments such as isoniazid and rifampicin.MDR-TB is a major global health challenge and needs to be controlled tightly through prevention measures,early diagnosis,and full treatment and management.What is added by this report?This outbreak was the first MDR-TB related public health emergency in Hubei Province.In total,five MDR-TB cases and nine clinically diagnosed cases were identified within one class in a secondary school.Students and teachers from other classes were monitored,but no other cases were found.What are the implications for public health practice?The implementation of TB prevention and control measures in schools is important to increase knowledge on TB and to raise awareness on protecting personal wellbeing.The Automatic Early Warning Information System alerted the local health department and allowed for a timely response to prevent further disease spread.
基金The National Natural Science Funds of China(Grant Numbers:81971939).
文摘Summary What is already known about topic?Multidrug-resistant tuberculosis(MDR-TB)has become a growing threat to public health.There were few reports about family-to-school MDR-TB outbreaks in China,especially during the coronavirus disease 2019(COVID-19)pandemic.What is added by this report?A tuberculosis(TB)outbreak happened in Hubei Province during the COVID-19 pandemic.The transmission chain was probably from a father(MDRTB case)with retreated TB history to his daughter,who then spread TB to her classmates.
基金Supported by the National Twelfth Five-Year Mega-Scientific Projects of Infectious Diseases in China(Grant Number 2013ZX10003-004-001).
文摘Summary What is already known about this topic?The association of diabetes mellitus(DM)with both increased risk of tuberculosis(TB)and unfavorable treatment outcomes has been identified by many studies(1).However,epidemic data for TB cases in DM patients is absent in China.What is added by this report?This current population-based prospective cohort study,conducted in ten counties located in eastern,central,and western China during 2013–2015,revealed a high prevalence and incidence of TB in known DM patients.Most TB cases were captured by active case-finding and a much higher presence of being asymptomatic among TB/DM patients was obtained.What are the implications for public health practice?Active case-finding should be carried out in DM patients and populations at high risk for developing TB.A TB symptom screening-based case-finding strategy is not enough;chest radiography check should be done once a year for these patients.
