【作者】 李秋燕；

【导师】 曹秀玲；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 结核病是一种由结核分枝杆菌引起的慢性传染性疾病,它不仅会影响患者的身体健康,甚至导致死亡,还会传染给周围人群,导致严重的公共卫生和社会问题；同时结核病也是一种贫穷病,越是贫困地区,患者越多。我国是世界上结核病负担最重的22个国家之一,结核病患病人数位居世界第二位；据估计,我国结核患者总数占全球四分之一,其中约85%的结核患者分布在广大农村。结核病作为一种慢性病,其病程较长、治疗周期长、费用高、疾病导致患者的劳动生产能力下降,社会有效劳动生产力减少,给患者家庭造成了沉重的经济负担,同时也给整个社会带来了巨大的经济损失。结核病在我国已成为农村人口因病致贫、因病返贫,制约农村特别是贫困地区经济和社会发展的重大疾病之一。本研究主要通过对山东省六县区已经结束治疗的肺结核患者的整个诊疗过程的调查,从家庭角度了解肺结核病给患者造成的疾病经济负担；探讨其影响因素,并分析各因素对肺结核患者疾病经济负担所造成的影响,据此提出相关的政策建议。具体目的如下：1.调查山东省六县区肺结核患者的社会人口学特征及家庭经济状况；2.调查肺结核患者诊疗过程情况及相关费用与时间损失情况；3.探讨不同社会人口学特征及家庭经济状况对肺结核患者疾病经济负担的影响；4.探讨不同诊疗过程对肺结核患者疾病经济负担的影响；5.根据以上结果,为减轻肺结核患者疾病经济负担,提出相关的政策建议。本研究采用的方法：本研究采用文献复习法获得肺结核疾病经济负担的研究背景和测算方法；采用分层整群随机抽样方法,抽取6个县区,36个乡镇；采用入户面对面访谈的方式,对每个乡镇中所有2006年10月1号到2007年9月30号登记的肺结核患者,进行问卷调查；对已经结束治疗的肺结核患者的人口学特征如性别、年龄、受教育程度、婚姻状况以及肺结核患者家庭经济状况等采用描述性分析；对患者直接经济负担、间接经济负担分别采用Kruskal-Wallis H检验和spearman相关分析等非参数检验方法进行单因素分析,对影响患者直接经济负担、间接经济负担的因素分别采用logistic回归模型进行多因素分析。本研究的主要结果：1.所调查的已经结束治疗的肺结核患者,例均疾病经济负担为5732.82元,中位数为3328.93元；其中,例均直接经济负担为5585.85元,中位数为3200元,例均间接经济负担为193.73元,中位数为73.17元,疾病经济负担占2007年平均年收入的65.40%。2.肺结核患者的家庭经济状况较差,家庭经济收入较低,而医疗花费较高,2007年家庭平均收入为8765.71元,人均年收入为2750.16元,2007年家庭年医疗保障支出平均为4486.55元。3.肺结核患者疾病经济负担的影响因素：①肺结核患者疾病经济负担存在地区差异,台儿庄区患者的直接费用最高,滨城区的最低,而金乡县肺结核患者的间接费用最高,滨城区的最低。②家庭经济状况与患者治疗的总费用无关,家庭经济收入低的患者,其支付能力较弱,却要支付相同的费用,疾病经济负担相对更重。③医生的疾病诊断水平对肺结核患者的疾病经济负担影响显著,患者确诊延误时间越长、确诊前就诊次数越多、确诊单位级别越高,患者的疾病经济负担越重。④住院患者的疾病经济负担更重,不必要的住院费用增加了患者的疾病经济负担。⑤多因素分析结果显示,影响肺结核患者直接经济负担的主要影响因素是地区、确诊单位、不同的化疗管理方式、是否住院；影响肺结核患者间接经济负担的主要影响因素是地区、就诊次数、初次就诊单位、是否住院。结论与建议：1.进一步加强对结核病相关防治知识的宣传,确保患者能及时到结防机构就诊、治疗,从而减少不必要的花费。2.进一步增加结核病防治经费投入,加大结核病的优惠范围,确保患者切实享受免费的检查和治疗。3.提高基层医疗机构医务人员的诊断水平,加强肺结核三级防治网建设,实行结核病归口管理、建立完善转诊制度,以节省医疗费用。4.严格规范医疗机构的治疗行为,规范肺结核患者的入院标准,减少患者不必要的住院治疗花费。5.建立有效的医疗保障体系,将肺结核病纳入新型农村合作医疗等医疗保障制度中,增加对肺结核患者的报销比例。更多还原

【Abstract】 Tuberculosis is a kind of chronic infections disease caused by mycobacterium tuberculosis. It not only influences the patient’s healthy, even to death, but also can infect the people around so as to cause serious public health and social problems. Meanwhile, Tuberculosis is also a disease of poverty; the poorer areas, the more patients. China is one of the 22 most TB burden countries in the world, and the prevalence of tuberculosis ranks second in the world. It is estimated that china’s total tuberculosis patients is a quarter of the world, among them, about 85% of tuberculosis patients in the vast rural areas. As a chronic disease, TB has characteristic of longer duration, longer treatment cycle, and the higher cost, what’s more, it can decrease patients’social labor production capacity and reduce the social effective labor productivity, so TB not only cause a severe economic burden to the family, but also cause huge economic loss to the whole society. TB has become one of the major diseases which lead to rural poverty, restrain the economic and social development in rural.ObjectiveIn order to understand the economic burden of disease of the tuberculosis patients and its influencing factors from the household perspective, to analyze the effect of various factors in the economic burden of disease of tuberculosis patients, we surveyed the tuberculosis patients in six counties in Shandong Province, so that we can put forward relevant policy suggestions for the prevention and controlling of TB in Shandong Province.The specific objectives of this study are as follows:1. To investigate the basic characteristic and the family economic situation of tuberculosis patients in different areas. 2. To investigate the process of diagnostic and treatment and the related expense and the time loss of the tuberculosis patients.3. To explore the effect on the economic burden of disease of TB patients with different demographic characteristic and economic conditions.4. To explore the effect on the economic burden of disease of TB patients with different diagnosis and treatment.5. To put forward relevant policy suggestions to reduce the TB disease economic burden based on the above results.MethodsObtained the backgrand and calculation methods of TB disease economic burden by literature review method; Sampled randomly six counties of Shandong Province thirty-six towns-ships by stratified-cluster-random sampling method; surveyed all the registered TB patients on October 1 st,2006 to September 30,2007 of each townships using the questionnaire by face-to-face interviews method. SPSS16.0 was used in this research Describe the characteristic of the TB patients such as sex, age, occupations and the family’s economic conditions by descriptive analysis; Kruskal- Wallis H test and spearmen-related analysis etal were used for single factor analysis of patients’ direct economic burden and indirect economic burden; Logistic regression analysis was used to explore the influencing factors.Main Results1. Among the tuberculosis patients who had been the end of treatment, the economic burden of one patients for 5732.82yuan, median3328.93yuan; among them, the direct economic burden of one TB patients for 5585.85yuan, with a median of 32 OOyuan, the indirect economic burden of one TB patients for 193.73yuan,with a median of 73.17yuan. The proportion of economic burden which accounts for 2007 average yearly income is 65.40%.2. The family economic situation was poorer and family income was lower, but the medical expense was higher among the TB patients. The annual household income was 8765.71yuan. Annual per capita income was 2750.16yuan and the annual expenditure of family medical care was 4484.55yuan. 3. The influencing factors of the disesse economic burden of the TB patients:①The disease economic burden of TB patients existed regional difference. The direct cost of the Taierzhuang TB patients was highest, lowest in Bincheng. The indirect cost of the Jinxiang TB patients was highest, lowest in Bincheng.②Economic status had nothing to do with the total cost of treatment, the lower family income of patients, the weaker ability to pay, but they must bear the same cost, so they should greater disease economic burden relatively.③The doctor’s diagnostic capacity has significantly affects on the disease economic burden of TB patients. The longer confirmed diagnosis delay, the more times for diagnosis before confirmed diagnosis, the higher diagnosis unit level, the heavier the patient’s disease economic burden.④The economic burden of inpatients is heavier, unnecessary hospital expenses increased the disease economic burden of the TB patients.⑤Logistic analysis results showed that the influencing factors of the direct economic burden of the TB patients were district, confirmed diagnosis unit level, different chemotherapeutical management mode and hospitalization; The influencing factors of the indirect economic burden of the TB patients were district, the first diagnosed unit, the times for diagnosis before confirmed diagnosis and hospitalization.Coclusions1. Further strengthen propaganda of the relevant prevention and controlling of tuberculosis knowledge, to ensure the TB patients can be diagnosed timely and antituberculosis therapy, so as to reduce the unnecessary expense.2. Further increases funding of TB controlling and prevention, increase the scope of preferential, to ensure patients to enjoy free examination and treatment.3. Improves the diagnosis capacity of the basic medical staff, implement centralized management of TB; strengthen TB tertiary prevention network construction; establish and perfect the TB referral system to save medical expensesof the TB patients.4. Strictly regulate the behavior of medical institutions and standard the inclusion criteria of tuberculosis inpatients with medical institutions to reduce unnecessary expense of TB inpatients.5. Establish effective medical security system, and put the tuberculosis into the medical security system such as the new rural cooperative medical scheme, to increase the reimbursement proportion of TB patients.更多还原