Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China.

Chengchao Zhou,Qiang Sun,Jiaying Chen,Henry Lucas,Qian Long,Shenglan Tang,Fei Huang,Li Xiang,Qiang Li

doi:10.1186/s40249-016-0100-6

Abstract

BackgroundTuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households. A number of studies have analyzed patient and household expenditure on TB care, but there does not appear to be any that have assessed the incidence, intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China. That will be the objective of this paper.MethodsThe data used for this study were derived from the baseline survey of the China Government – Gates Foundation TB Phase II program. Our analysis included 747 TB cases. Catastrophic health expenditure for TB care was estimated using two approaches, with households defined as experiencing CHE if their annual expenditure on TB care: (a) exceeded 10 % of total household income; and (b) exceeded 40 % of their non-food expenditure (capacity to pay). Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE.ResultsThe incidence of CHE was 66.8 % using the household income measure and 54.7 % using non-food expenditure (capacity to pay). An inverse association was observed between CHE rates and household income level. Significant determinants of CHE were: age, household size, employment status, health insurance status, patient income as a percentage of total household income, hospitalization and status as a minimum living security household. Factors including gender, marital status and type of TB case had no significant associations with CHE.ConclusionsCatastrophic health expenditure incidence from TB care is high in China. An integrated policy expanding the free treatment package and ensuring universal coverage, especially the height of UHC for TB patients, is needed. Financial and social protection interventions are essential for identified at-risk groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0100-6) contains supplementary material, which is available to authorized users.

Highlights

Tuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households
Almost 55 % of households incurred catastrophic health expenditure (CHE) for TB care using a threshold of 40 % of non-food expenditure and this increased to 87 % if the threshold was set to 10 %
The findings indicate that incidence and intensity of CHE for households of TB patients were both high in China

Summary

Introduction

Tuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households. A number of studies have analyzed patient and household expenditure on TB care, but there does not appear to be any that have assessed the incidence, intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China. Protecting people from financial risk associated with ill health is a desirable objective of health policy worldwide [1,2,3,4]. Such risk can be quantified in terms of catastrophic health expenditures (CHE). Small expenditures for common illnesses may have serious financial implications for poor households [1, 6,7,8,9]. The World Health Organization (WHO) has promoted the concept of universal health coverage (UHC), emphasizing

Objectives

Methods

Results

Discussion

Conclusion