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

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Abstract

Background

Tuberculosis patients often experience hospitalization. Inpatient services may result in high medical expenditures. It is important to explore the hospitalization rates of tuberculosis patients and the potential factors that are associated with admission rates and inpatient service expenditures.

Methods

Data from patients diagnosed and treated at the No.3 hospital of Zhenjiang City from Apr. 2014 to Mar. 2015 were obtained. Univariate and multivariate statistical analyses were applied for the analysis of potential factors associated with admission rates, average length of stay and cost.

Results

A total of 356 tuberculosis patients were treated at the No.3 hospital of Zhenjiang City. A total of 221 of the 356 patients were hospitalized. Sputum smear test results and type of health insurance were the potential factors associated with hospitalization rates. The average admission was (1.26 ± 0.64) per patient. The average length of stay of inpatients was 29.99 ± 25.83 days. Age, occupation, and sputum smear test were related to the average length of stay. The average total cost to inpatients was 13007.91 ± 5205.58 CNY. The sputum smear test results, type of health insurance, occupation and age were the main potential factors associated with TB inpatient expenditures.

Conclusions

The admission rate of tuberculosis patients was high. Despite advances in TB insurance policies, there were substantial costs associated with TB diagnosis and treatment. TB patients still face a heavy financial burden. Health care providers should revise the service package and reform the health insurance regulations to ensure that TB patients receive appropriate care.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3892-9) contains supplementary material, which is available to authorized users.

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Most cited references 26

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Progress in tuberculosis control and the evolving public-health system in China

Longde Wang, Jianjun Liu, Daniel Chin (2007)

Summary China has the world's second largest tuberculosis epidemic, but progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. The spread of severe acute respiratory syndrome (SARS) in 2003, brought to light substantial weaknesses in the country's public-health system. After the SARS epidemic was brought under control, the government increased its commitment and leadership to tackle public-health problems and, among other efforts, increased public-health funding, revised laws that concerned the control of infectious diseases, implemented the world's largest internet-based disease reporting system, and started a programme to rebuild local public-health facilities. These measures contributed to acceleration in efforts to control tuberculosis. By 2005, the detection of cases of tuberculosis had increased to 80% of the estimated total new cases, permitting China to achieve the 2005 global tuberculosis control targets. At the same time, specific efforts to improve tuberculosis control also contributed to strengthening of the public-health system. We examine how the strengthening of a disease control programme and the public-health system worked together to achieve a desired health outcome.

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Adherence to anti-tuberculosis treatment among pulmonary tuberculosis patients: a qualitative and quantitative study

Weiguo Xu, Wei-Wei Lu, Yang Zhou … (2009)

Background Tuberculosis (TB) patients have difficulty following a long-term treatment regimen. Efforts to improve treatment outcomes require better understanding of adherence as a complex behavioral issue and of the particular barriers to and facilitators of patient adherence. Methods This study was carried out in Jiangsu Province of China with both quantitative and qualitative approaches. For the quantitative study, 780 sputum-smear positive TB patients consecutively registered since 2006 in 13 counties (districts) were queried with a structured questionnaire. Patients who had missed 10% of their total prescribed doses of TB drugs were deemed as non-adherent. Risks for non-adherence were estimated by computing odds ratios (ORs) and their 95% confidence intervals (95% CIs) using a logistic regression model. We also invited 20 TB patients and 10 local health workers for in-depth interviews. We then used content analysis based on this qualitative study to explore factors associated with non-adherence. Results The proportion of non-adherence among 670 patients was 12.2%. Univariate analysis showed that patients, who were illiterate, divorced/widowed, lacked health insurance and were migrants, were more likely to be non-adherent. The crude ORs(95%CIs) were 2.38(1.37-4.13), 2.42(1.30-4.52), 1.89(1.07-3.32) and 1.98(1.03-3.83), respectively. The risk of non-adherence was lower among patients whose treatment was given under direct observation by village doctors or regular home visits by health workers, with ORs (95% CIs) of 0.19(0.10-0.36) and 0.23(0.10-0.51), respectively. In multivariate analysis, factors associated with non-adherence included illiteracy (OR: 2.42; 95% CI: 1.25-4.67) and direct observation by village doctors (OR: 0.23; 95% CI: 0.11-0.45). The in-depth interviews indicated that financial burdens and extra medical expenditures, adverse drug reactions, and social stigma were additional potential factors accounted for non-adherence. Conclusion More importance should be given to treatment adherence under the current TB control program. Heavy financial burdens, lack of social support, adverse drug reactions and personal factors are associated with non-adherence. Direct observation and regular home visits by health workers appear to reduce the risk of non-adherence. More patient-centered interventions and greater attention to structural barriers are needed to improve treatment adherence.

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Analysis of the economic burden of diagnosis and treatment of tuberculosis patients in rural China.

Yan H Shen, H. Pan, Y. Feng … (2013)

A county in Jiangsu Province, China. To estimate the costs of the diagnosis and treatment of tuberculosis (TB) from the patient's perspective and to identify determinants of the patient's financial burden. In a cross-sectional survey, we interviewed 316 patients diagnosed from January 2010 to May 2011 who had already completed their anti-tuberculosis treatment. The financial burden on TB patients included out-of-pocket costs and productivity losses. The average per capita total out-of-pocket cost was 3024.0 Chinese yuan (CNY), with a median cost of 1086 CNY (interquartile range [IQR] 480-2456). Mean out-of-pocket medical and non-medical costs were respectively 2565.7 CNY and 458.3 CNY. Productivity lost by patients and family members was 2615.2 CNY (median 500, IQR 250-2025). Factors associated with out-of-pocket costs and productivity losses included hospitalisation, adverse drug reactions, cost of drugs to 'protect' the liver, cost of second-line anti-tuberculosis drugs and diagnostic delay. Although the government of China has implemented a 'free TB service policy', the economic burden on patients is still heavy. More patient-centred interventions are essential to reduce the financial burden on patients.

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Author and article information

Contributors

Yang Zhou: zhouyang@jscdc.cn

Cheng Chen: 3818244@qq.com

Hui Jiang: zjcdcjh@163.com

Hong-Qiu Pan: zjpanhongqiu@163.com

Li-Mei Zhu: zulimei905@126.com

Wei Lu:

ORCID: http://orcid.org/0000-0002-5811-847X

weiluxx@yeah.net

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 18 January 2019

Publication date PMC-release: 18 January 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 47

Affiliations

[1 ]Department of Chronic Disease Control and Prevention, Centers for Disease Control and Prevention of Jiangsu Province, 172 Jiangsu Road, Nanjing, 210009 Jiangsu Province People’s Republic of China

[2 ]Centers for Disease Control and Prevention of Zhenjiang City, Zhenjiang, Jiangsu Province People’s Republic of China

[3 ]No.3 Hospital of Zhenjiang City, Zhenjiang, Jiangsu Province People’s Republic of China

Author information

Wei Lu http://orcid.org/0000-0002-5811-847X

Article

Publisher ID: 3892

DOI: 10.1186/s12913-019-3892-9

PMC ID: 6339337

PubMed ID: 30658635

SO-VID: fc1df10f-c538-4694-91dd-8fd8db249c6a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 28 February 2018

Date accepted : 9 January 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

Award ID: 51914

Funded by: the Health Reseach fund of Jiangsu provincial commission of health and family planning

Award ID: Z201505

Award Recipient : Yang Zhou

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: tuberculosis,inpatient,financial burden,china

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: tuberculosis, inpatient, financial burden, china

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

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China Occupational Medicine

Most cited references 26

Progress in tuberculosis control and the evolving public-health system in China

Adherence to anti-tuberculosis treatment among pulmonary tuberculosis patients: a qualitative and quantitative study

Analysis of the economic burden of diagnosis and treatment of tuberculosis patients in rural China.

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