方便真的是王道吗?越南公立和私立医疗机构结核病灾难性成本的比较评估:一项纵向患者成本研究。

IF 8.1 1区 医学
Hoa Binh Nguyen, Luan Nguyen Quang Vo, Rachel Jeanette Forse, Anja Maria Christine Wiemers, Huy Ba Huynh, Thuy Thi Thu Dong, Yen Thi Hoang Phan, Jacob Creswell, Thi Minh Ha Dang, Lan Huu Nguyen, Jad Shedrawy, Knut Lönnroth, Tuan Dinh Nguyen, Luong Van Dinh, Kristi Sidney Annerstedt, Andrew James Codlin
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引用次数: 0

摘要

背景:在越南,肺结核(TB)是一种破坏性的生命事件,其代价高昂,部分原因是在公共医疗机构接受每日直接观察治疗所造成的收入损失。因此,肺结核患者可能会寻求私立医疗机构的治疗,因为私立医疗机构具有灵活性、便利性和私密性。我们的研究旨在衡量受结核病影响的家庭在公共部门和私营部门的收入变化、费用和灾难性费用发生情况:2020 年 10 月至 2022 年 3 月期间,我们在越南河内、海防和胡志明市对 50 名接受私人治疗的肺结核患者和 60 名接受国家肺结核计划(NTP)治疗的肺结核患者进行了 110 次纵向患者费用访谈。采用世界卫生组织结核病患者成本调查工具的本地化改编版,在强化治疗阶段、继续治疗阶段和治疗后对参与者进行了访谈。我们使用 Wilcoxon 秩和检验和卡方检验比较了两个组群的收入水平、直接和间接治疗费用、灾难性费用,并使用多变量回归比较了相关风险因素:私营部门队列的治疗前家庭月收入中位数明显高于 NTP 队列(868 美元对 578 美元;P = 0.010)。然而,私营部门的治疗费用也明显更高(2075 美元对 1313 美元;P = 0.005),直接医疗费用是国家结核病防治计划参与者报告费用的 4.6 倍(754 美元对 164 美元;P 结论:在越南,结核病患者面临着巨大的经济压力:越南的肺结核患者无论是在公立医院还是私立医院接受治疗,都面临着同样高的灾难性费用风险。可以通过扩大保险报销范围来减少患者的费用,从而最大限度地降低私营部门的直接医疗费用,在公共部门使用远程监测和多周/多月给药策略来避免经济成本,并在总体上提供更多的社会保障机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is convenience really king? Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam: a longitudinal patient cost study.

Background: In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector.

Methods: Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression.

Results: The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36-138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64-44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72-831.73; P = 0.021).

Conclusions: Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.

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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty INFECTIOUS DISEASES-
自引率
1.20%
发文量
368
期刊介绍: Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.
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