Inequity in catastrophic costs among tuberculosis-affected households in China

Infectious Diseases of Poverty

Yan Liu¹  Li Wang¹  Hemant Deepak Shewade²  Hui Zhang³  Li-Xia Wang³  Cai-Hong Xu³  Yin-Yin Xia³  Kathiresan Jeyashree⁴ 

[1]Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College

[2]International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office

[3]National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention

[4]Velammal Medical College Hospital and Research Institute

关键词: Catastrophic health expenditure, tuberculosis;    Patient cost;    Universal health coverage;    Social protection;    Equity;   

DOI  :  10.1186/s40249-019-0564-2

来源: DOAJ

【 摘 要 】

Abstract Background There are limited nationally representative studies globally in the post-2015 END tuberculosis (TB) era regarding wealth related inequity in the distribution of catastrophic costs due to TB care. Under the Chinese national tuberculosis programme setting, we aimed to assess extent of equity in distribution of total TB care costs (pre-treatment, treatment and overall) and costs as a proportion of annual household income (AHI), and describe and compare equity in distribution of catastrophic costs (pre-treatment, treatment and overall) across population sub-groups. Methods Analytical cross-sectional study using data from national TB patient cost survey carried out in 22 counties from six provinces in China in 2017. Drug-susceptible pulmonary TB registered under programme, who had received at least 2 weeks of intensive phase therapy were included. Equity was depicted using concentration curves and concentration indices were compared using dominance test. Results Of 1147 patients, the median cost of pre-treatment, treatment and overall care, were USD 283.5, USD 413.1 and USD 965.5, respectively. Richer quintiles incurred significantly higher pre-treatment and treatment costs compared to poorer quintiles. The distribution of costs as a proportion of AHI and catastrophic costs were significantly pro-poor overall as well as during pre-treatment and treatment phase. All the concentration curves for catastrophic costs (due to pre-treatment, treatment and overall care) stratified by region (east, middle and west), area of residence (urban, rural) and type of insurance (new rural co-operative medical system [NCMS], non-NCMS) also exhibited a pro-poor pattern with statistically significant (P <  0.01) concentration indices. The pro-poor distribution of the catastrophic costs due to TB treatment was significantly more inequitable among rural, compared to urban patients, and NCMS compared to non-NCMS beneficiaries. Conclusions There is inequity in the distribution of catastrophic costs due to TB care. Universal health coverage, social protection strategies complemented by quality TB care is vital to reduce inequitable distribution of catastrophic costs due to TB care in China.

【 授权许可】

Unknown