The Effect of an Innovative Financing and Payment Model for Tuberculosis Patients on Health Service Utilization in China: Evidence from Hubei Province of China
The Effect of an Innovative Financing and Payment Model for Tuberculosis Patients on Health Service Utilization in China: Evidence from Hubei Province of China
复制标题
结核病患者创新融资和支付模式对中国医疗服务利用的影响：来自中国湖北省的证据
DOI：
10.3390/ijerph16142494
复制
发表时间：
2019-07-02
影响因子：
--
通讯作者：
Tang, Shenglan
中科院分区：
文献类型：
--
作者：
Jiang, Junnan;Lucas, Henry;Tang, Shenglan
背景：结核病（TB）仍然是中国主要的社会和公共卫生问题。“中国-盖茨结核病项目”始于2012年，其目标之一是减轻结核病患者的经济负担，并改善获得高质量结核病治疗的机会。本研究的目的是确定该项目是否对提高卫生服务利用率有积极影响。方法：“中国盖茨结核病项目”于2014年4月在湖北省宜昌市启动，2015年3月结束，为期1年。在基线和最终评估时，对YC三个县的540名患者进行了一系列问卷调查。采用描述性统计方法，对计划实施前后的住院和门诊服务利用情况进行评估。采用倾向评分匹配法评价中国-盖茨结核病项目对卫生服务利用的影响。举行了焦点小组讨论，以进一步丰富成果。结果：共有530例患者纳入本研究。住院率从33.5%显著增加到75.9%（p < 0.001），低收入患者的住院率增加最多。门诊就诊次数从4.6次增加到5.6次（p < 0.001），最贫困患者的增加幅度也最大。与生活在发达县的人相比，偏远的五峰县因病门诊的总体增幅更高。结论：中国-盖茨结核病项目有效地提高了YC的卫生服务利用率，贫困患者从中受益更多，偏远欠发达县的结核病患者更倾向于增加门诊服务而不是住院服务。需要使政策向穷人倾斜，需要采取各种措施，以确保不发达地区利用保健服务。
Background: Tuberculosis (TB) remains a major social and public health problem in China. The "China-Gates TB Project" started in 2012, and one of its objectives was to reduce the financial burden on TB patients and to improve access to quality TB care. The aims of this study were to determine if the project had positive impacts on improving health service utilization. Methods: The 'China-Gates TB Project' was launched in Yichang City (YC), Hubei Province in April 2014 and ended in March 2015, lasting for one year. A series of questionnaire surveys of 540 patients were conducted in three counties of YC at baseline and final evaluations. Inpatient and outpatient service utilization were assessed before and after the program, with descriptive statistics. Propensity score matching was used to evaluate the impact of the China-Gates TB Project on health service utilization by minimizing the differences in the other characteristics of baseline and final stage groups. Focus group discussions (FGDs) were held to further enrich the results. Results: A total of 530 patients were included in this study. Inpatient rates significantly increased from 33.5% to 75.9% overall (p < 0.001), with the largest increase occurring for low income patients. Outpatient visits increased from 4.6 to 5.6 (p < 0.001), and this increase was also greatest for the poorest patients. Compared with those who lived in developed counties, the overall increase in outpatient visits for illness in the remote Wufeng county was higher. Conclusions: The China-Gates TB Project has effectively improved health service utilization in YC, and poor patients benefited more from it. TB patients in remote underdeveloped counties are more likely to increase the use of outpatient services rather than inpatient services. There is a need to tilt policy towards the poor, and various measures need to be in place in order to ensure health services utilization in undeveloped areas.