Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China
Abstract Background Certain districts and counties in China designated local general hospital as the designated hospital for tuberculosis (TB) management after the promulgation of the Law of Practicing Physicians in 2009. To our knowledge, there is limited research on catastrophic payments of TB pat...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-020-09136-z |
| _version_ | 1818884396987449344 |
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| author | Tianchi Yang Tong Chen Yang Che Qin Chen Dingyi Bo |
| author_facet | Tianchi Yang Tong Chen Yang Che Qin Chen Dingyi Bo |
| author_sort | Tianchi Yang |
| collection | DOAJ |
| description | Abstract Background Certain districts and counties in China designated local general hospital as the designated hospital for tuberculosis (TB) management after the promulgation of the Law of Practicing Physicians in 2009. To our knowledge, there is limited research on catastrophic payments of TB patients under this service model, often with inconsistent conclusions. In addition, there has been no published studies from China using the updated 2018 World Health Organization (WHO) definition of catastrophic total costs due to TB. This study used the latest criterion recommended by the WHO to analyze the incidence of catastrophic total costs for households affected by TB under the designated hospital model and explore its influencing factors. Methods A cross-sectional analysis was carried out in all ten designated hospitals in Ningbo, China. Eligible pulmonary TB cases confirmed by sputum culture of Mycobacterium tuberculosis were recruited and surveyed from September 2018 to October 2018. We evaluated catastrophic total costs using total costs for TB treatment exceeding 20% of the household’s annual pre-TB income. A sensitivity analysis was performed while varying the thresholds. The least absolute shrinkage and selection operator (LASSO) regression were applied to select variables, and multiple logistic regression analysis were used to identify the determinants of catastrophic total costs. Results A total of 672 patients were included, with a median age of 41 years old. The rate of catastrophic total costs of surveyed households was 37.1%, and that of households affected by MDR was 69.6%. Medical cost accounted for more than 60% of the total cost. 57.7% cases were hospitalized. The hospitalization rates of patients with no comorbidities, no severe adverse drug reactions, and rifampin-sensitive TB were 53.9, 54.9, and 55.3%, respectively. Patients in the poorest households had the highest hospitalization rates (Q1:54.8%, Q2:61.4%, Q3:52.2%, Q4:49.5%, Q5:69.7%, P = 0.011) and the highest incidence of severe adverse drug reactions (Q1:29.6%, Q2:19.6%, Q3:28.0%, Q4:33.7%, Q5:35.3%, P = 0.034). Factors such as elderly, minimum living security, unemployed before or after illness, poor economic status, seeking medical care outside the city, hospitalization, absence of local basic medical insurance coverage and MDR were positively associated with catastrophic costs. Conclusion Substantial proportions of patients and households affected by pulmonary TB faced catastrophic economic risks in Ningbo, China. The existing policies that focus on expanding the coverage of basic medical insurance and economic protection measures (such as cash transfers to compensate low-income households for direct non-medical costs and income loss) might be insufficient. Tailored program that mitigate inappropriate healthcare and address equity of care delivery are worthy of attention. |
| first_indexed | 2024-12-19T15:48:53Z |
| format | Article |
| id | doaj.art-1dc89c4df0874401a8c14158e03fb673 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-19T15:48:53Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-1dc89c4df0874401a8c14158e03fb6732022-12-21T20:15:15ZengBMCBMC Public Health1471-24582020-06-0120111310.1186/s12889-020-09136-zFactors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in ChinaTianchi Yang0Tong Chen1Yang Che2Qin Chen3Dingyi Bo4Institute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and PreventionInstitute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and PreventionInstitute of Tuberculosis Prevention and Control, Ningbo Municipal Center for Disease Control and PreventionDivision of Medical Insurance, Ningbo Huamei Hospital, University of Chinese Academy of SciencesInstitute of Infectious Disease Control, Haishu District Center for Disease Control and PreventionAbstract Background Certain districts and counties in China designated local general hospital as the designated hospital for tuberculosis (TB) management after the promulgation of the Law of Practicing Physicians in 2009. To our knowledge, there is limited research on catastrophic payments of TB patients under this service model, often with inconsistent conclusions. In addition, there has been no published studies from China using the updated 2018 World Health Organization (WHO) definition of catastrophic total costs due to TB. This study used the latest criterion recommended by the WHO to analyze the incidence of catastrophic total costs for households affected by TB under the designated hospital model and explore its influencing factors. Methods A cross-sectional analysis was carried out in all ten designated hospitals in Ningbo, China. Eligible pulmonary TB cases confirmed by sputum culture of Mycobacterium tuberculosis were recruited and surveyed from September 2018 to October 2018. We evaluated catastrophic total costs using total costs for TB treatment exceeding 20% of the household’s annual pre-TB income. A sensitivity analysis was performed while varying the thresholds. The least absolute shrinkage and selection operator (LASSO) regression were applied to select variables, and multiple logistic regression analysis were used to identify the determinants of catastrophic total costs. Results A total of 672 patients were included, with a median age of 41 years old. The rate of catastrophic total costs of surveyed households was 37.1%, and that of households affected by MDR was 69.6%. Medical cost accounted for more than 60% of the total cost. 57.7% cases were hospitalized. The hospitalization rates of patients with no comorbidities, no severe adverse drug reactions, and rifampin-sensitive TB were 53.9, 54.9, and 55.3%, respectively. Patients in the poorest households had the highest hospitalization rates (Q1:54.8%, Q2:61.4%, Q3:52.2%, Q4:49.5%, Q5:69.7%, P = 0.011) and the highest incidence of severe adverse drug reactions (Q1:29.6%, Q2:19.6%, Q3:28.0%, Q4:33.7%, Q5:35.3%, P = 0.034). Factors such as elderly, minimum living security, unemployed before or after illness, poor economic status, seeking medical care outside the city, hospitalization, absence of local basic medical insurance coverage and MDR were positively associated with catastrophic costs. Conclusion Substantial proportions of patients and households affected by pulmonary TB faced catastrophic economic risks in Ningbo, China. The existing policies that focus on expanding the coverage of basic medical insurance and economic protection measures (such as cash transfers to compensate low-income households for direct non-medical costs and income loss) might be insufficient. Tailored program that mitigate inappropriate healthcare and address equity of care delivery are worthy of attention.http://link.springer.com/article/10.1186/s12889-020-09136-zTuberculosisCatastrophic total costsDesignated hospitalFactors |
| spellingShingle | Tianchi Yang Tong Chen Yang Che Qin Chen Dingyi Bo Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China BMC Public Health Tuberculosis Catastrophic total costs Designated hospital Factors |
| title | Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China |
| title_full | Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China |
| title_fullStr | Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China |
| title_full_unstemmed | Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China |
| title_short | Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China |
| title_sort | factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model a cross sectional study in china |
| topic | Tuberculosis Catastrophic total costs Designated hospital Factors |
| url | http://link.springer.com/article/10.1186/s12889-020-09136-z |
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