Evaluating the costs associated with tuberculosis (TB)-related treatment, care, and services among low-income individuals in rural Guangxi, China Öffentlichkeit

Abstract

Introduction: China has the third highest prevalence of tuberculosis (TB) in the world. The burden of TB is especially high in the south-central province of Guangxi, which is considered to be a rural area where many low-income farmers reside. While TB treatment is advertised to be free for patients with health insurance in China, many individuals diagnosed with TB report that they still pay high costs to manage their TB disease. There is very little research that exists on the economic burden of seeking TB treatment, care, and services (both direct and indirect costs) among these poor and rural populations in Guangxi.

Methods: Two counties were identified in Guangxi (County A and County B) to have a high burden of TB among poor and rural residents, most of who were farmers. In each county, a data collection form was administered through in-home visits or telephone interviews to patients at least 18 years of age who were listed in the 2013 TB registry (n=128 in County A and n=79 in County B). Patients were asked about their demographic information, TB diagnosis, hospital expenses, and access to transportation.

Results: Our final response rate in County A was 76.6% (n=98) and 74.7% in County B (n=59). The top drivers for total expenditures incurred by TB patients in County A are the patient's injection fee (r=0.94567, p<0.0001), drug fee (r=0.94189, p<0.0001), and laboratory fee (r=0.88779, p<0.0001). In County B, these variables are the patient's injection fee (r=0.88118, p<0.0001), drug fee (r=0.85564, p<0.0001), and lodging fee (r=0.82617, p<0.0001).

Discussion: Patients in both counties reported incurring high hospitalization costs while being treated for TB. Many patients do not seek treatment until their TB symptoms become worse and are hospitalized longer, which results in higher costs associated with TB treatment and services. As most patients are rural sustenance farmers and generate little income, it is difficult to manage their total hospital expenditures that are not covered by insurance. The results of this study should be used to urge Chinese health authorities to reform the current insurance system to consider special subsidized funding in low socioeconomic areas.

Table of Contents

I. Introduction 1

II. Literature Review 8

Description of decentralized health services for TB diagnosis and treatment 8

Types of models 10

Economic burden for patients diagnosed with TB 11

Intervention strategies 13

Migrant populations 14

Economic burden of TB in other countries 15

III. Methods 16

Introduction 16

Population and Sample 17

Research Design 17

Procedures 18

Telephone Interviews 18

In-person Interviews 19

Survey Instruments 20

Data Analysis 21

Ethical Considerations 21

Statistics Analysis Plan 21

IV. Results 25

Table 1a: Categorical Variables between County A and County B 25

Table 1b: Statistical Differences of Continuous Variables between County A and County B 27

Table 2a: Univariate Spearman Correlation between Continuous Variables and Total Expenditures within Each County 30

County A 31

County B 32

Table 2b: Wilcoxon Rank-Sum Tests/ Kruskal-Wallis (K-W) for Association with Total Expenditures within Each County 33

County A 33

County B 33

V. Discussion 33

Study Limitations 39

Data Analysis Limitations 41

VI. Implications/Recommendations 41

VII. Appendix 45

Appendix A. Telephone Script 45

Appendix B. Data Collection Form #1 48

Appendix C. Description of Variables and Codes 56

VIII. References 58

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	economic burden rural tuberculosis guangxi China
Committee Chair / Thesis Advisor	Castro, Kenneth G, Emory University Brachman, Philip S, Emory University
Committee Members	Moore, Renee H, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Non-US governmental agency (e.g., Minister of Health in Haiti)

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