Abstract
BackgroundChina has recently adopted the “TB designated hospital model” to improve the quality of tuberculosis (TB) treatment and patient management. Considering that inpatient service often results in high patient financial burden, and therefore influences patient adherence to treatment, it is critical to better understand the TB patient admission rate and TB inpatient service cost, as well as their influential factors in this new model.MethodsQuantitative and qualitative studies were conducted in two cities, Hanzhong in Shaanxi Province and Zhenjiang in Jiangsu Province, in China. Quantitative data were obtained from a sample survey of 533 TB patients and TB inpatient records from 2010–2012 in six county designated hospitals. Qualitative information was obtained through interviews with key stakeholders (40 key informant interviews, 14 focus group discussions) and reviews of health policy documents in study areas. Both univariate and multivariate statistical analyses were applied for the quantitative analysis, and the thematic framework approach was applied for the qualitative analysis.ResultsThe TB patient admission rates in Zhenjiang and Hanzhong were 54.8 and 55.9 %, respectively. Qualitative analyses revealed that financial incentives, misunderstanding of infectious disease control and failure of health insurance regulations were the key factors associated with the admission rates and medical costs. Quantitative analyses found differences in hospitalization rate existed among patients with different health insurance and patients from different counties. Average medical costs for TB inpatients in Jurong and Zhenba were 7,215 CNY and 4,644 CNY, which was higher than the 5,500 CNY and 3,800 CNY limits set by the New Rural Cooperative Medical System. No differences in medical cost or length of stay were found between patients with and without comorbidities in county-level hospitals.ConclusionsTB patient admission rates and inpatient service costs were relatively high. Studies of related factors indicated that a package of interventions, including health education programs, reform of health insurance regulations and improvement of TB treatment guidelines, are urgently required to ensure that TB patients receive appropriate care.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0097-x) contains supplementary material, which is available to authorized users.
Highlights
China has recently adopted the “TB designated hospital model” to improve the quality of tuberculosis (TB) treatment and patient management
This paper provides estimates of admission rates and medical costs of TB inpatients in two cities in China, explores the factors that are potentially associated with high admission rates via a mixed method
Almost 87 % were covered by the New Rural Cooperative Medical System (NCMS) (82 % in Zhenjiang, 92 % in Hanzhong), 8.8 % by the Urban Employee Basic Medical Insurance (UEBMI), and 2.6 % by the Urban Resident Basic Medical Insurance (URBMI)
Summary
China has recently adopted the “TB designated hospital model” to improve the quality of tuberculosis (TB) treatment and patient management. Since 2003, China has adopted a “designated hospital model” in the eastern part of the country to further improve the quality of TB treatment and patient management, under which selected hospitals undertake both TB outpatient/inpatient services and patient management [4, 5]. Policymakers and researchers have being concerned about how the new TB policies will control TB patient admission rates and the cost of TB inpatient services. According to the National TB Control Program Guidelines in China [10], inpatient services are regarded as essential only for severely ill patients, those with comorbidities or associated conditions and patients with adverse reactions
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