Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and...Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.展开更多
Background:Tuberculosis(TB)often causes catastrophic economic effects on both the individual suffering the disease and their households.A number of studies have analyzed patient and household expenditure on TB care,bu...Background:Tuberculosis(TB)often causes catastrophic economic effects on both the individual suffering the disease and their households.A number of studies have analyzed patient and household expenditure on TB care,but there does not appear to be any that have assessed the incidence,intensity and determinants of catastrophic health expenditure(CHE)relating to TB care in China.That will be the objective of this paper.Methods:The data used for this study were derived from the baseline survey of the China Government–Gates Foundation TB Phase Ⅱ program.Our analysis included 747 TB cases.Catastrophic health expenditure for TB care was estimated using two approaches,with households defined as experiencing CHE if their annual expenditure on TB care:(a)exceeded 10%of total household income;and(b)exceeded 40%of their non-food expenditure(capacity to pay).Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE.Results:The incidence of CHE was 66.8%using the household income measure and 54.7%using non-food expenditure(capacity to pay).An inverse association was observed between CHE rates and household income level.Significant determinants of CHE were:age,household size,employment status,health insurance status,patient income as a percentage of total household income,hospitalization and status as a minimum living security household.Factors including gender,marital status and type of TB case had no significant associations with CHE.Conclusions:Catastrophic health expenditure incidence from TB care is high in China.An integrated policy expanding the free treatment package and ensuring universal coverage,especially the height of UHC for TB patients,is needed.Financial and social protection interventions are essential for identified at-risk groups.展开更多
Background:There are limited nationally representative studies globally in the post-2015 END tuberculosis(TB)era regarding wealth related inequity in the distribution of catastrophic costs due to TB care.Under the Chi...Background:There are limited nationally representative studies globally in the post-2015 END tuberculosis(TB)era regarding wealth related inequity in the distribution of catastrophic costs due to TB care.Under the Chinese national tuberculosis programme setting,we aimed to assess extent of equity in distribution of total TB care costs(pre-treatment,treatment and overall)and costs as a proportion of annual household income(AHI),and describe and compare equity in distribution of catastrophic costs(pre-treatment,treatment and overall)across population sub-groups.Methods:Analytical cross-seaional study using data from national TB patient cost survey carried out in 22 counties from six provinces in China in 2017.Drug-susceptible pulmonary TB registered under programme,who had received at least 2 weeks of intensive phase therapy were included.Equity was depiaed using concentration curves and concentration indices were compared using dominance test.Results:Of 1147 patients,the median cost of pre-treatment,treatment and overall care,were USD 283.5,USD 413.1 and USD 965.5,respectively.Richer quintiles incurred significantly higher pre-treatment and treatment costs compared to poorer quintiles.The distribution of costs as a proportion of AHI and catastrophic costs were significantly pro-poor overall as well as during pre-treatment and treatment phase.All the concentration curves for catastrophic costs(due to pre-treatment,treatment and overall care)stratified by region(east,middle and west),area of residence(urban,rural)and type of insurance new rural co-operative medical system[NCMS],non-NCMSalso exhibited a pro-poor pattern with statistically significant(P<0.01)concentration indices.The pro-poor distribution of the catastrophic costs due to TB treatment was significantly more inequitable among rural,compared to urban patients,and NCMS compared to non-NCMS beneficiaries.Conclusions:There is inequity in the distribution of catastrophic costs due to TB care.Universal health coverage,social protection strategies complemented by quality TB care is vital to reduce inequitable distribution of catastrophic costs due to TB care in China.展开更多
Background:Diabetes mellitus(DM)is a major public health concern in India,and entails a severe burden in terms of disability,death,and economic cost.This study examined the out-of-pocket health expenditure(OOPE)and fi...Background:Diabetes mellitus(DM)is a major public health concern in India,and entails a severe burden in terms of disability,death,and economic cost.This study examined the out-of-pocket health expenditure(OOPE)and financial burden associated with DM care in India.Methods:The study used data from the latest round of the National Sample Survey on health,which covered 555,115 individuals from 113,823 households in India.In the present study,data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed.Results:In India,10.04 per 1000 persons reported having DM during the last 15 days before the survey date,varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas.Nearly 38%of Indian households with diabetic members experienced catastrophic health expenditure(at the 10%threshold)and approximately 10%of DM-affected households were pushed below the poverty line because of OOPE,irrespective of the type of care sought.48.5%of households used distressed sources to finance the inpatient costs of DM.Medicines constituted one of the largest proportion of total health expenditure,regardless of the type of care sought or type of healthcare facility visited.The average monthly OOPE was over 4.5-fold and 2.5-fold higher for households who sought inpatient and outpatient care,respectively,from private health facilities,compared with those treated at public facilities.Notably,the financial burden was more severe for households residing in rural areas,those in lower economic quintiles,those belonging to marginalised social groups,and those using private health facilities.Conclusion:The burden of DM and its associated financial ramifications necessitate policy measures,such as prioritising health promotion and disease prevention strategies,strengthening public healthcare facilities,improved regulation of private healthcare providers,and bringing outpatient services under the purview of health insurance,to manage the diabetes epidemic and mitigate its financial impact.展开更多
文摘目的基于上海市近年结核病诊疗费用减免政策,探索耐多药结核病(multidrug resistant tuberculosis,MDR-TB)患者疾病经济负担及其影响因素,为优化MDR-TB诊疗费用减免政策和综合管理模式提供依据。方法收集上海市2017—2019年确诊MDR-TB患者情况和诊疗费用减免情况数据,开展针对疾病经济负担的问卷调查,建立涵盖患者人口和社会经济情况、临床特征、疾病经济负担和诊疗费用减免情况数据库,明确患者疾病经济负担和灾难性卫生支出(catastrophic health expenditure)发生情况。以多元线性回归法分析可能影响患者疾病经济负担的因素,以多因素logistic回归法分析不同比例下灾难性卫生支出发生的影响因素。结果196例纳入研究分析的MDR-TB患者平均年龄为(44±16)岁,男性139例(占70.9%),上海户籍占46.4%,49%的患者为家庭主要劳动力。治疗期间,患者自付诊疗费用中位数为4.0(四分位数区间2.0~6.5)万元。113例患者获得减免诊疗,减免费用中位数为2.6(四分位数区间1.3~4.9)万元。若自付费用占家庭年收入的40%及以上,有47.8%的患者会发生灾难性支出;若不考虑减免政策,有59.8%的患者发生灾难性卫生支出。上海户籍(OR=0.3,95%CI为0.1~1.0)、更低家庭收入水平(P_(trend)=0.002)、医疗保险类型[(农村合作医疗保险/外来人口综合保险(OR=13.3,95%CI为1.0~171.2),无医疗保险(OR=17.5,95%CI为2.7~113.0)]和既往结核病治疗史(OR=3.3,95%CI为1.1~10.0)可能影响灾难性卫生支出的发生。结论上海市MDR-TB患者的自付诊疗费用较高。医疗保障力度较小和家庭经济情况不佳的患者更易发生高额自付费用,导致灾难性卫生支出。上海市MDR-TB诊疗费用减免政策有效降低了患者的经济负担。
基金supported by the Bill and Melinda Gates Foundation (No. OPP1216421)CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2021-I2M-1004)。
文摘Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.
基金The study upon which this paper was written is part of the large program entitled“China National Health and Family Planning Commission and the Gates Foundation TB Project”-a collaboration between the Government of China and the Melinda and Bill Gates Foundation(Grant No.51914)implemented by the China Center of Disease Control and Prevention(CDC)。
文摘Background:Tuberculosis(TB)often causes catastrophic economic effects on both the individual suffering the disease and their households.A number of studies have analyzed patient and household expenditure on TB care,but there does not appear to be any that have assessed the incidence,intensity and determinants of catastrophic health expenditure(CHE)relating to TB care in China.That will be the objective of this paper.Methods:The data used for this study were derived from the baseline survey of the China Government–Gates Foundation TB Phase Ⅱ program.Our analysis included 747 TB cases.Catastrophic health expenditure for TB care was estimated using two approaches,with households defined as experiencing CHE if their annual expenditure on TB care:(a)exceeded 10%of total household income;and(b)exceeded 40%of their non-food expenditure(capacity to pay).Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE.Results:The incidence of CHE was 66.8%using the household income measure and 54.7%using non-food expenditure(capacity to pay).An inverse association was observed between CHE rates and household income level.Significant determinants of CHE were:age,household size,employment status,health insurance status,patient income as a percentage of total household income,hospitalization and status as a minimum living security household.Factors including gender,marital status and type of TB case had no significant associations with CHE.Conclusions:Catastrophic health expenditure incidence from TB care is high in China.An integrated policy expanding the free treatment package and ensuring universal coverage,especially the height of UHC for TB patients,is needed.Financial and social protection interventions are essential for identified at-risk groups.
文摘Background:There are limited nationally representative studies globally in the post-2015 END tuberculosis(TB)era regarding wealth related inequity in the distribution of catastrophic costs due to TB care.Under the Chinese national tuberculosis programme setting,we aimed to assess extent of equity in distribution of total TB care costs(pre-treatment,treatment and overall)and costs as a proportion of annual household income(AHI),and describe and compare equity in distribution of catastrophic costs(pre-treatment,treatment and overall)across population sub-groups.Methods:Analytical cross-seaional study using data from national TB patient cost survey carried out in 22 counties from six provinces in China in 2017.Drug-susceptible pulmonary TB registered under programme,who had received at least 2 weeks of intensive phase therapy were included.Equity was depiaed using concentration curves and concentration indices were compared using dominance test.Results:Of 1147 patients,the median cost of pre-treatment,treatment and overall care,were USD 283.5,USD 413.1 and USD 965.5,respectively.Richer quintiles incurred significantly higher pre-treatment and treatment costs compared to poorer quintiles.The distribution of costs as a proportion of AHI and catastrophic costs were significantly pro-poor overall as well as during pre-treatment and treatment phase.All the concentration curves for catastrophic costs(due to pre-treatment,treatment and overall care)stratified by region(east,middle and west),area of residence(urban,rural)and type of insurance new rural co-operative medical system[NCMS],non-NCMSalso exhibited a pro-poor pattern with statistically significant(P<0.01)concentration indices.The pro-poor distribution of the catastrophic costs due to TB treatment was significantly more inequitable among rural,compared to urban patients,and NCMS compared to non-NCMS beneficiaries.Conclusions:There is inequity in the distribution of catastrophic costs due to TB care.Universal health coverage,social protection strategies complemented by quality TB care is vital to reduce inequitable distribution of catastrophic costs due to TB care in China.
文摘Background:Diabetes mellitus(DM)is a major public health concern in India,and entails a severe burden in terms of disability,death,and economic cost.This study examined the out-of-pocket health expenditure(OOPE)and financial burden associated with DM care in India.Methods:The study used data from the latest round of the National Sample Survey on health,which covered 555,115 individuals from 113,823 households in India.In the present study,data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed.Results:In India,10.04 per 1000 persons reported having DM during the last 15 days before the survey date,varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas.Nearly 38%of Indian households with diabetic members experienced catastrophic health expenditure(at the 10%threshold)and approximately 10%of DM-affected households were pushed below the poverty line because of OOPE,irrespective of the type of care sought.48.5%of households used distressed sources to finance the inpatient costs of DM.Medicines constituted one of the largest proportion of total health expenditure,regardless of the type of care sought or type of healthcare facility visited.The average monthly OOPE was over 4.5-fold and 2.5-fold higher for households who sought inpatient and outpatient care,respectively,from private health facilities,compared with those treated at public facilities.Notably,the financial burden was more severe for households residing in rural areas,those in lower economic quintiles,those belonging to marginalised social groups,and those using private health facilities.Conclusion:The burden of DM and its associated financial ramifications necessitate policy measures,such as prioritising health promotion and disease prevention strategies,strengthening public healthcare facilities,improved regulation of private healthcare providers,and bringing outpatient services under the purview of health insurance,to manage the diabetes epidemic and mitigate its financial impact.
