Objective To understand the treatment costs of pulmonary tuberculosis (PTB) patients in Zhabei district,Shanghai,and their satisfaction with the derating policy,so as to provide evidences for improving TB derating policy and reducing economic burden of the patients.Methods Two hundred and sixty-five PTB patients registered for derating treatment fees at Zhabei District Center for Disease Control and Prevention from July 2015 to July 2016 were recruited to participate in this study.The invoices of non-derated medical costs were collected and questionnaire survey on satisfaction with the derating policy was conducted.A total of 265 questionnaires were sent out and 213 valid questionnaires were collected (all 213 patients were aware of the derating policy).The effective response rate was 80.4％.Basic characteristics including demographic data,treatment and medication data were collected;Ranksum test was used to compare the costs supported by government financial between patients with different characteristics;the costs at patients' own expense on the related examinations and medicines were calculated;and the satisfaction with the derating policy were also analyzed by using questionnaire.Results The median exempted costs of the total medical expenses for the 213 patients was 1766 (1020,2411) RMB (quartile (Q1,Q3)),of which 655 (377,900) RMB for medical examinations,325 (165,493) RMB for first-line anti-TB drugs,293 (85,733) RMB for second-line anti-TB drugs,and 800 (156,800) RMB for hepatoprotective drugs,respectively.Among the non-exempted costs,the times of kidney function test and blood routine examination were 6.4 and 6.6 per patient,resulting in average fees of 156.8 (33 388/213) and 79.6 (16 954/213) RMB,respectively;the average cost at patients'own expense on auxiliary drugs (such as anti-TB Traditional Chinese Medicine Patent Prescription) was 684.8 RMB.The overall satisfaction rate of patients with derating policy was 77.5％ (165/213).With regard to first-line anti-TB drugs,hepatoprotective drugs,medical examinations and process of derating,the satisfaction rates were 90.1％ (192/213),77.9％ (166/213),83.1％ (177/213) and 90.6％ (193/213),respectively.65.3％ (139/213) of the patients believed that hepatoprotective drugs account for the majority of the total treatment costs.For the current derating policy,the proportion of patients who chose "The items that can be derated were limited" or "The costs that can be derated were low" were 51.2％ (109/213) and 34.7％ (74/213),respectively.The most expected item to be implemented on the basis of current policy was derating the expenses when treating at designated hospital (45.5％,97/213).Conclusion The overall satisfaction rate of the patients with derating policy is low in Zhabei district.Considering the actual treatment situation of patients in this district,we should increase derated costs of some examinations and medicines.%目的 对上海市闸北区肺结核患者治疗费用情况和对闸北区现行的肺结核治疗费用减免政策的满意度进行调查,以便进一步优化、完善闸北区肺结核减免政策,切实为减轻患者医疗费用负担提供依据.方法 2015年7月至2016年7月间,以闸北区疾病预防控制中心登记减免的全部肺结核患者265例作为研究对象,收集其非减免部分的诊疗发票并进行减免满意度问卷调查,调查问卷发出265份,共收集有效问卷213份(213例患者对减免政策均知晓),有效应答率为80.4％.研究内容包括:患者人口学特征、治疗及用药等基本情况;采用秩和检验方法比较不同类型患者治疗费用减免情况,统计患者非减免且自费部分的相关检查及药物费用;采用问卷调查了解患者对现行减免政策的满意度情况.结果 213例患者的治疗费用减免金额中位数[四分位数(Q,Q)]为1766(1020,2411)元,其中,检查项目例均减免655(377,900)元,一线抗结核药物例均减免325(165,493)元,二线抗结核药物例均减免293(85,733)元,护肝药物例均减免800(156,800)元.非减免费用中,患者肾功能及血常规例均检查次数分别为6.4次、6.6次,例均检查金额分别为156.8元(33 388/213)、79.6元(16 954/213);抗结核中成药等辅助药物的例均自费金额为684.8元.患者对减免政策的总体满意度为77.5％(165/213),对一线抗结核药物、护肝药物、检查项目、减免流程4个方面的满意度调查显示,患者选择满意的比率分别为90.1％(192/213)、77.9％(166/213)、83.1％(177/213)、90.6％(193/213).患者各项治疗费用中,认为护肝药物占总费用最重者占65.3％(139/213);对于目前的减免政策,患者认为减免项目少及减免比例低者分别占51.2％(109/213)、34.7％(74/213);在目前减免政策基础上,选择希望增加在定点医院直接减免的患者占45.5％(97/213).结论 我区肺结核患者对治疗费用减免政策的总体满意度相对较低,建议结合我区肺结核患者治疗的实际情况,扩大部分检查及药物费用的减免.
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