High admission rates and heavy inpatient service costs of urban tuberculosis patients in eastern China

摘要

BackgroundChina is one of the “high burden countries” of tuberculosis (TB), there were 889,000 new TB cases in 2017 according to the estimates of the World Health Organization (WHO). China has the second highest TB epidemic rate in the world [1].TB remains a serious public health issue and social problem in many developing nations [2]. The Chinese government attaches much importance to TB control. Since the 1990s, the Chinese government has implemented the National Tuberculosis Control Program (NTP), the DOTS strategy, free TB diagnosis and treatment, and DOTS-plus to constantly enhance TB control measures [3].TB has been regarded as a “poverty-related disease” due to its association with poverty and malnutrition [4]. Poverty can decrease the rate of treatment success [5], and TB will also aggravate poverty. In China, suspected tuberculosis patients are provided free diagnosis and anti-tuberculosis treatment, including free chest X-ray examinations, sputum smear tests and designated first-line anti-tuberculosis drugs. However, some patients still cannot afford the share of medical and non-medical costs [6].Recently, tuberculosis management models have been changing in China. The diagnosis and treatment of TB patients have been transferred from the Centers for Disease Control and Prevention (CDC) to “designated hospitals”. Each county has one designated hospital for TB treatment. The designated hospital is usually a public hospital in the county, and most of them are the largest healthcare provider in the county [7]. In China, patients are more likely to seek medical service in the public hospital, including suspected and confirmed TB patients. The 2000 national TB survey reported that 91% of TB patients visited public hospitals first to treat TB related symptoms [8]. Additionally, TB patients receive better diagnosis and treatment in the designated hospitals, and can also increase adherence to anti-tuberculosis treatment. However, the designated hospital model also has its own disadvantages; patients may not receive the free diagnosis and anti-tuberculosis treatment or they may experience over-examination and a high rate of hospitalization due to poor hospital staff training for TB technical specifications and the economic incentive of the designated hospital. Research from Dr. Li [9] revealed that the rate of hospitalization increased significantly from 62.3 to 98.0%, and the ALOS increased 2 to 4?days after the diagnosis and treatment of TB patients transferred to the designated hospitals. These resulted in a greater financial burden on patients and reduced the likelihood of treatment adherence. Some patients default because of the high financial burden of TB [10].In 2013, China launched a collaboration with the Bill and Melinda Gates Foundation TB Programme. Under this programme, three project sites, including Zhenjiang City Jiangsu Province, implemented a new policy to standardize TB diagnosis and treatment at the designated hospital and improve reimbursement rates for TB patients. In this paper, we evaluated the effectiveness of the programme. We analysed the admission rates and economic burden of TB patients in Zhenjiang City, and we also explored the potential factors that are associated with high admission rates and inpatient service costs.