Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study

Abstract

ObjectiveTo investigate the extent and associations of patient/diagnostic delay and other potential factors with catastrophic health expenditure (CHE) for tuberculosis (TB) care in Chongqing municipality, China.DesignA cross-sectional study.SettingFour counties of Chongqing municipality, China.ParticipantsA total of 1199 patients with active pulmonary TB beyond 16 years and without mental disorders were consecutively recruited in the four counties’ designated TB medical institutions.Outcome measuresThe incidence and intensity of CHE for TB care were described. The association between patients’ ‘sociodemographic and clinical characteristics such as patient delay, diagnostic delay, forms of TB, health insurance status and hospitalisation and CHE were analysed using univariate and multivariate logistic regression.ResultsThe incidence of CHE was 52.8% and out-of-pocket (OOP) payments were 93% of the total costs for TB care. Compared with patients without delay, the incidence and intensity of CHE were higher in patients who had patient delay or diagnostic delay. Patients who experienced patient delay or diagnostic delay, who was a male, elderly (≥60 years), an inhabitant, a peasant, divorced/widow, the New Cooperative Medical Scheme membership had greater risks of incurring CHE for TB care. Having a higher educational level appeared to be a protective factor. However, hospitalisation was not associated with CHE after controlling for other variables.ConclusionThe incidence and intensity of CHE for TB care are high, which provides baseline data about catastrophic costs that TB-related households faced in Chongqing of China. Variety of determinants of CHE implicate that it is essential to take effective measures to promote early seeking care and early diagnosis, improve the actual reimbursement rates of health insurance, especially for outpatients, and need more fine-tuned interventions such as precise poverty alleviation to reduce catastrophic costs of the vulnerable population.

Analysis of the economic burden of diagnosis and treatment on patients with tuberculosis in Bao’an district of Shenzhen City, China

“…Only 35.6% of patients reported that they were diagnosed with suspected TB at their first visit, and the rest were informed that they had pneumonia, pleurisy, upper respiratory infection, and so on. Consistent with our study, other investigators pointed out that early diagnosis of TB reduced costs while achieving treatment success [29,30]. The total number of registered active TB cases were 1317, included 76(5.8%) native case and 1241(94.2%) migrant cases in Bao'an district in 2013 [31].…”

Factors associated with catastrophic total costs due to tuberculosis under a designated hospital service model: a cross-sectional study in China

“…For example, Zhou C, etc. found that hospitalization is an important determinant of the occurrence of CHE [9], while in a study by Duan et al, despite observed strong association between hospitalization and CHE, the association was not statistically significant after adjusting for potential confounding factors (aOR:1.342, 95%CI: 0.950-1.897) [8]. The conflicting findings from two studies could probably resulted from the rates of patients participating in the New Cooperative Medical Scheme, an insurance specifically designed to cover more disadvantaged rural population.…”

“…To date, there have been few studies on catastrophic health expenditures (CHE) of TB patients under the designated hospital model in China, and the conclusions are not consistent [8,9]. For example, Zhou C, etc.…”

“…The conflicting findings from two studies could probably resulted from the rates of patients participating in the New Cooperative Medical Scheme, an insurance specifically designed to cover more disadvantaged rural population. Because place of residence and type of health insurance scheme are highly confounded with inpatient service utilization patterns, the difference in insurance status distributions likely caused conflicting results [8,9]. However, Li X, etc.…”

Catastrophic health expenditures of households living with pediatric leukemia in China

“…13 When a household must reduce its basic expenses over a period of time in order to cope with OOP payments, it is viewed as a catastrophic health expenditure (CHE). CHE is an index associated with the proportion of OOP payments that exceed a given threshold of the total household income (eg, 10%) 14,15 or the total household expenditures (eg, 40%) within a given year. 16 CHE may expose households to a significant risk of impoverishment and can result in economic burden for both developing and developed countries.…”