【摘要】 目的比较定点医院模式与疾控模式结核病人的疾病经济负担差异。方法采用描述性分析方法,根据行政区域及医防合作模式的不同,选择4个地区为研究现场,分市区和县级2组进行比较,在4个地区各随机抽取约60例初治涂阳肺结核患者,共242例作为研究对象,进行问卷调查了解患者疾病经济负担。结果 4个调查点,患者治疗平均总费用在3 911~7 505元不等,占患者家庭年收入的38%~51%,其中市级定点医院模式治疗总费用比疾控模式高85.2%(t=2.10,P=0.04),县城两种模式患者治疗总费用差异无统计学意义(P=0.69)。市区定点医院模式总住院率(34.4%)比市区疾控模式(8.5%)高,差异有统计学意义((χ2=41.72,P<0.01)),县城定点医院模式总住院率(38.7%),与县城疾控模式(28.3%)相比,差异无统计学意义(P=0.22)。结论两种模式下病人的疾病负担均较重,建议将结核病纳入当地医疗保障制度报销范围,并逐步提高结核病住院和门诊治疗花费的报销比例,同时做好对定点医院的补偿工作,严格控制患者住院比例及收费标准。更多还原

【Abstract】 Objective To compare the economical burden of patients with tuberculosis during the treatment indesignated hospital and TB dispensary. Methods A descriptive study was carried out in 4 different settings according to TBadministrative model. Sixty patients were randomly chosen from each setting and a total of 242 subjects were enrolled. Datawere collected by a uniform questionnaire and stratified for analysis using software. Results The average cost for treatmentvaried from 3 911yuan to 7 505 yuan in 4 regions and accounted for 38~51% of the patient’s annual household income. Themedical fee charged by municipal designated hospital was 85.2% higher than that charged by the municipal TB dispensary(t=2.10,P=0.04), and also a higher admission rate was observed in the municipal designated hospital(34.4% vs 8.5%, χ2=3.97,P=0.04). There was no significant difference in the treatment expenses between county designated hospital and county TBdispensary, and neither in the admission rate(38.7% vs 28.3%, P=0.22).Conclusion TB patients from 4 regions had heavyfinancial burden. It seems reasonable to expand the medical insurance to cover tuberculosis and raise the proportion ofreimbursement for both the inpatient and outpatient At the same time, it is necessary to strengthen the supervision of designatedhospital about hospitalization and charge standard, and give them the proper compensation更多还原