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首页> 美国卫生研究院文献>International Journal of Environmental Research and Public Health >The Effect of an Innovative Financing and Payment Model for Tuberculosis Patients on Health Service Utilization in China: Evidence from Hubei Province of China
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The Effect of an Innovative Financing and Payment Model for Tuberculosis Patients on Health Service Utilization in China: Evidence from Hubei Province of China

机译：中国结核病患者创新融资和支付模式对卫生服务利用的影响：来自湖北省的证据

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Background: Tuberculosis (TB) remains a major social and public health problem in China. The “China–Gates TB Project” started in 2012, and one of its objectives was to reduce the financial burden on TB patients and to improve access to quality TB care. The aims of this study were to determine if the project had positive impacts on improving health service utilization. Methods: The ‘China–Gates TB Project’ was launched in Yichang City (YC), Hubei Province in April 2014 and ended in March 2015, lasting for one year. A series of questionnaire surveys of 540 patients were conducted in three counties of YC at baseline and final evaluations. Inpatient and outpatient service utilization were assessed before and after the program, with descriptive statistics. Propensity score matching was used to evaluate the impact of the China–Gates TB Project on health service utilization by minimizing the differences in the other characteristics of baseline and final stage groups. Focus group discussions (FGDs) were held to further enrich the results. Results: A total of 530 patients were included in this study. Inpatient rates significantly increased from 33.5% to 75.9% overall (p < 0.001), with the largest increase occurring for low income patients. Outpatient visits increased from 4.6 to 5.6 (p < 0.001), and this increase was also greatest for the poorest patients. Compared with those who lived in developed counties, the overall increase in outpatient visits for illness in the remote Wufeng county was higher. Conclusions: The China–Gates TB Project has effectively improved health service utilization in YC, and poor patients benefited more from it. TB patients in remote underdeveloped counties are more likely to increase the use of outpatient services rather than inpatient services. There is a need to tilt policy towards the poor, and various measures need to be in place in order to ensure health services utilization in undeveloped areas.
机译：背景：结核病（TB）仍然是中国的主要社会和公共卫生问题。 “中国-门结核病项目”于2012年启动，其目标之一是减轻结核病患者的经济负担，并改善获得优质结核病护理的机会。这项研究的目的是确定该项目是否对提高卫生服务利用率产生积极影响。方法：“中国-门结核病项目”于2014年4月在湖北省宜昌市启动，至2015年3月结束，历时一年。在基线和最终评估时，在YC的三个县对540名患者进行了一系列问卷调查。在该计划前后对住院和门诊服务利用情况进行评估，并提供描述性统计数据。倾向得分匹配用于通过最大程度地减少基线组和末期组其他特征之间的差异来评估中国盖茨结核项目对卫生服务利用的影响。举行了焦点小组讨论，以进一步丰富结果。结果：本研究共纳入530名患者。住院率从总体的33.5％显着提高到75.9％（p <0.001），其中最大的增长发生在低收入患者身上。门诊就诊次数从4.6增加到5.6（p <0.001），对于最贫穷的患者，这种增加也最大。与生活在发达县城的人相比，偏远的五峰县的疾病门诊总数总体上有所增加。结论：中国—门结核病项目有效地改善了青年中心的卫生服务利用，贫困患者从中受益更多。偏远欠发达县的结核病患者更有可能增加门诊服务而不是住院服务的使用。有必要向穷人倾斜政策，需要采取各种措施以确保在欠发达地区利用卫生服务。

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