The NHS visitor and migrant cost recovery programme - a threat to health?
The NHS visitor and migrant cost recovery programme - a threat to health?
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DOI：
10.1186/s12889-020-08524-9
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发表时间：
2020-04-20
影响因子：
4.5
通讯作者：
Griffiths, C. J.
中科院分区：
文献类型：
--
作者：
Potter, J. L.;Burman, M.;Griffiths, C. J.
背景2014年4月，英国政府推出了“NHS访客和移民成本回收计划实施计划”，其中规定了一系列政策变化，以收回“收费”（主要是非英国出生）患者的成本。在英格兰，大约75%的结核病病例发生在国外出生的人身上。结核病治疗的延误增加了社区发病、死亡和传播的风险。我们调查了自成本回收计划（CRP）推出以来，诊断延迟是否有所增加。方法2011年1月1日至2016年12月31日期间，Barts Health NHS Trust在伦敦结核病登记处报告了3342例成人结核病病例。排除相关信息缺失的病例。根据出生地计算CRP前后症状发作和治疗开始之间的中位时间，并使用Mann Whitney检验进行比较。延迟诊断被认为大于或等于所有患者的中位治疗时间（79天）。单变量逻辑回归用于手动选择暴露变量，以纳入多变量模型，以检验诊断延迟与CRP实施之间的相关性。结果共纳入肺结核病例2237例。在非英国出生的患者中，在引入CRP后，中位治疗时间从69天增加到89天（p < 0.001）。英国出生人群的中位至治疗时间也从75.5天增加至89.5天（p = 0.307）。多变量logistic回归模型显示，非英国出生的患者在CRP后更有可能出现诊断延迟（adjOR 1.37，95% CI 1.13-1.66，p值0.001）。结论自CRP引入以来，非英国出生的结核病患者的治疗出现了明显的延迟。如果我们希望在全国范围内消除结核病，迫切需要进一步研究探索限制移民获得医疗保健的政策的影响。
Background In April 2014 the UK government launched the 'NHS Visitor and Migrant Cost Recovery Programme Implementation Plan' which set out a series of policy changes to recoup costs from 'chargeable' (largely non-UK born) patients. In England, approximately 75% of tuberculosis (TB) cases occur in people born abroad. Delays in TB treatment increase risk of morbidity, mortality and transmission in the community. We investigated whether diagnostic delay has increased since the Cost Recovery Programme (CRP) was introduced. Methods There were 3342 adult TB cases notified on the London TB Register across Barts Health NHS Trust between 1st January 2011 and 31st December 2016. Cases with missing relevant information were excluded. The median time between symptom onset and treatment initiation before and after the CRP was calculated according to birthplace and compared using the Mann Whitney test. Delayed diagnosis was considered greater or equal to median time to treatment for all patients (79 days). Univariable logistic regression was used to manually select exposure variables for inclusion in a multivariable model to test the association between diagnostic delay and the implementation of the CRP. Results We included 2237 TB cases. Among non-UK born patients, median time-to-treatment increased from 69 days to 89 days following introduction of CRP (p < 0.001). Median time-to-treatment also increased for the UK-born population from 75.5 days to 89.5 days (p = 0.307). The multivariable logistic regression model showed non-UK born patients were more likely to have a delay in diagnosis after the CRP (adjOR 1.37, 95% CI 1.13-1.66, p value 0.001). Conclusion Since the introduction of the CRP there has been a significant delay for TB treatment among non-UK born patients. Further research exploring the effect of policies restricting access to healthcare for migrants is urgently needed if we wish to eliminate TB nationally.