Out-of-pocket payment and catastrophic health expenditure of tuberculosis patients in accessing care at public-private mix clinics in Myanmar, 2022.

IF 8.1 1区 医学 Infectious Diseases of Poverty Pub Date : 2024-11-05 DOI:10.1186/s40249-024-01248-7
Myat Noe Thiri Khaing, Nandi U, Luu Maw, Htet Arkar, Saw Pa Pa Naing, May Me Thet
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Abstract

Background: The financial burden of tuberculosis (TB) can hinder patients and their families, creating obstacles throughout the care cascade, despite TB prevention and control being provided free of charge. In Myanmar, patients can visit private providers operating under public-private mix (PPM) schemes, where TB services (diagnosis and treatment) are typically offered at no cost. The study focused on quantifying the financial burden faced by TB patients seeking care from Myanmar's PPM providers.

Methods: This cross-sectional telephone survey included 695 adults seeking TB treatment [drug-susceptible TB (DS-TB) and retreatment TB] from various private providers in four states and regions with high TB burden in Myanmar. Telephone interviews were conducted in May and June 2022. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2022 and estimated throughout pre- and post-TB treatment episodes. The TB-affected households were defined as experiencing catastrophic health expenditure if their expenditure due to TB exceeded 20% of their capacity to pay, as recommended by the World Health Organization. All cost data were collected in Myanmar Kyats (MMK) and converted to USD (1 USD = 1850 MMK as of July 20, 2022). Logistic regression analysis was done to identify the determinants of catastrophic health expenditure.

Results: The findings showed patients made a median of 7 times for clinic visits throughout their treatment, with the median total cost for the entire TB treatment being 53.4 US dollars (USD), including direct medical and testing costs (11.9 USD) and direct non-medical patient expenditure (11.6 USD). Pre-treatment costs were higher compared to post-treatment costs (the intensive phase and continuation phase). During the intensive phase, TB care cost was nearly free, but during the continuation phase, it was a median of 2.6 USD. About 34.5% of patients experienced catastrophic health expenditure due to TB treatment, with expenses exceeding 20% of their capacity to pay. Multivariate regression analysis revealed that patients with a history of hospitalization (aOR = 14.84; P < 0.01), seeking care from regions other than Yangon (aOR = 2.6; P < 0.01), and using coping strategies (aOR = 12.53; P < 0.01), were more likely to face catastrophic financial burdens. Higher monthly household income (over 162 USD) was associated with a decreased risk of incurring catastrophic health expenditure (aOR = 0.38; P < 0.01).

Conclusions: TB patients and their households in Myanmar faced risk of catastrophic costs, even when treated in the private sector with free diagnostic charges and anti-TB medicine. The study highlighted the need for additional strategies or policies to make TB care affordable and mitigate the financial burden of TB-affected households.

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2022 年缅甸结核病患者在公私混合诊所就医时的自付费用和灾难性医疗支出。
背景:尽管结核病预防和控制是免费提供的,但结核病(TB)带来的经济负担会阻碍患者及其家人的治疗,给整个治疗过程造成障碍。在缅甸,患者可以到公私合营(PPM)计划下的私营医疗机构就诊,那里通常免费提供结核病服务(诊断和治疗)。这项研究的重点是量化向缅甸公私合营医疗机构寻求治疗的肺结核患者所面临的经济负担:这项横断面电话调查包括在缅甸四个结核病负担较重的邦和地区寻求各种私营医疗机构提供的结核病治疗(药物敏感性结核病(DS-TB)和再治疗结核病)的 695 名成年人。电话访谈于 2022 年 5 月和 6 月进行。从患者及其家庭的角度出发,对 2022 年发生的直接和间接费用进行了估价,并对结核病治疗前后的整个过程进行了估算。根据世界卫生组织的建议,如果受结核病影响的家庭因结核病产生的支出超过其支付能力的 20%,则将其定义为灾难性医疗支出。所有费用数据均以缅甸缅元(MMK)为单位收集,并兑换成美元(截至 2022 年 7 月 20 日,1 美元=1850 缅甸缅元)。为确定灾难性医疗支出的决定因素,我们进行了逻辑回归分析:结果显示,患者在整个治疗过程中的就诊次数中位数为 7 次,整个结核病治疗的总费用中位数为 53.4 美元,其中包括直接医疗和检测费用(11.9 美元)以及患者的直接非医疗支出(11.6 美元)。治疗前的费用高于治疗后的费用(强化阶段和继续治疗阶段)。在强化治疗阶段,结核病治疗费用几乎为零,但在继续治疗阶段,费用中位数为 2.6 美元。约 34.5% 的患者因结核病治疗而出现灾难性医疗支出,支出超过了其支付能力的 20%。多变量回归分析表明,有过住院史的患者(aOR = 14.84;P 结论:.....:缅甸的肺结核患者及其家庭面临着灾难性费用的风险,即使在私营部门接受免费诊断和抗结核药物治疗也是如此。该研究强调,有必要制定更多的战略或政策,使结核病治疗费用可负担得起,并减轻受结核病影响家庭的经济负担。
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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty INFECTIOUS DISEASES-
自引率
1.20%
发文量
368
期刊介绍: Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.
期刊最新文献
Role of social innovations in health in the prevention and control of infectious diseases: a scoping review. Approaching onchocerciasis elimination in Equatorial Guinea: Near zero transmission and public health implication. Global burden associated with rare infectious diseases of poverty in 2021: findings from the Global Burden of Disease Study 2021. One-year impact of behavioural interventions on schistosomiasis-related knowledge, attitude and practices of primary schoolchildren in Pemba, Tanzania. Establishing a dominant early larval sex-selection strain in the Asian malaria vector Anopheles stephensi.
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