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Open AccessArticle

Factors Influencing Hospitalization Rates and Inpatient Cost of Patients with Tuberculosis in Jiangsu Province, China: An Uncontrolled before and after Study

by 1,2,†, 3,†, 1,2, 1,2, 4,* and 5
1
School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
2
Creative Health Policy Research Group, Nanjing Medical University, Nanjing 211166, China
3
Global Health Research Center, Duke Kunshan University, Jiangsu 215316, China
4
National Center for Tuberculosis Control and Prevention, China CDC, Beijing 102206, China
5
Environmental Research Center, Duke Kunshan University, Jiangsu 215316, China
*
Author to whom correspondence should be addressed.
Dan Hu and Qian Long are co-first authors.
Int. J. Environ. Res. Public Health 2019, 16(15), 2750; https://doi.org/10.3390/ijerph16152750
Received: 5 July 2019 / Revised: 22 July 2019 / Accepted: 27 July 2019 / Published: 1 August 2019
(This article belongs to the Section Infectious Disease Epidemiology)
Objective: The China Center for Disease Control and Prevention (CDC) introduced an innovative financing model of tuberculosis (TB) care and control with the aim of standardizing TB treatment and reducing the financial burden associated with patients with TB. This is a study of the pilot implementation of new financing mechanism in Zhenjiang, between 2014–2015. We compared TB hospitalization rates and inpatient service costs before and after implementation to examine the factors associated with hospital admissions. Our goal is to provide evidence-based recommendations for improving TB service provision and cost control. Methods: We reviewed new policy documents on TB financing. We conducted a patient survey to investigate the utilization of inpatient services, and patients’ out-of-pocket payment for inpatient care. We extracted total medical expenditures of inpatient services from inpatient records of TB designated hospitals. Findings: 63.6% (n = 159) of the surveyed patients with TB were admitted for treatment in 2015, which was higher than that in 2013 (54.8%, n = 144). The number of hospital admission was slightly lower in 2015 (1.16 per patient) than in 2013 (1.26 per patient), while the length of hospital stay was longer in 2015 (24 days) than in 2013 (16 days). In 2015, patients from families with low incomes were more likely to be admitted than those from higher income groups (OR = 3.06, 95% CI: 1.12–8.33). The average inpatient service cost in 2015 (3345 USD) was 1.7 times the cost in 2013 (1952 USD). It was found that 96.2% of patients with TB who were from low-income households spent more than 20% of their household income on inpatient care in 2013, versus 100% in 2015. Conclusion: The TB hospital admission rate and total inpatient service cost increased over the study period. The majority of patients with TB, particularly poor patient who used inpatient care, continue to suffer from heavy financial burden. View Full-Text
Keywords: Tuberculosis; hospital admission rates; health financing and payment; financial burden; China Tuberculosis; hospital admission rates; health financing and payment; financial burden; China
MDPI and ACS Style

Hu, D.; Long, Q.; Chen, J.; Wang, X.; Huang, F.; Ji, J.S. Factors Influencing Hospitalization Rates and Inpatient Cost of Patients with Tuberculosis in Jiangsu Province, China: An Uncontrolled before and after Study. Int. J. Environ. Res. Public Health 2019, 16, 2750.

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