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Is convenience really king? Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam: a longitudinal patient cost study

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贫困所致传染病(英文) 2024年第2期13卷 1-12页

作者： Nguyen Hoa Binh Quang Vo Luan Nguyen Forse Rachel Jeanette Wiemers Anja Maria Christine Huynh Huy Ba Dong Thuy Thi Thu Phan Yen Thi Hoang Creswell Jacob Dang Thi Minh Ha Nguyen Lan Huu Shedrawy Jad L?nnroth Knut Nguyen Tuan Dinh Van Dinh Luong annerstedt kristi sidney Codlin Andrew James National Lung Hospital Ha Noi Viet Nam Friends for International TB Relief Ha Noi Viet Nam Department of Global Public Health WHO Collaboration Centre On Tuberculosis and Social Medicine Karolinska Institute Stockholm Sweden Stop TB Partnership Geneva Switzerland Pham Ngoc Thach Hospital Ho Chi Minh City Viet Nam

Background In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private *** Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate *** The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578;P=0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313;P=0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164;P<0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%;P=0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio [(aOR=13.71; 95% confidence interval (CI): 1.36–138.14;P=0.026], unemployment during treatment (aOR=10.86; 95%CI: 2.64–44.60;P<0.001) and experiencing TB-related stigma (aOR=37.90; 95%CI: 1.72–831.73;P=0.021).Conclusions Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the

关键词： Tuberculosis Patient cost Catastrophic cost Private sector Comparative analysis Viet Nam

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Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya

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Infectious Diseases of Poverty 2021年第4期10卷 18-32页

作者： Beatrice Kirubi Jane Ong'angto Peter Nguhiu Knut Lonnroth Aiban Rono kristi sidney-annerstedt Department of Global Public Health Karolinska InstitutetStockholmSweden WHO Collaborating Centre for Tuberculosis and Social Medicine StockholmSweden The Health and Social Protection Action Research&Knowledge Sharing Network(SPARKS) StockholmSweden Centre for Respiratory Disease Research Kenya Medical Research InstituteNairobiKenya Health Economics Research Unit KEMRI-WellcomeTrust Research ProgramNairobiKenya Monitoring Evaluation&ResearchNational TuberculosisLeprosy and Lung Disease ProgramMinistry of HealthNairobiKenya

Background::Despite free diagnosis and treatment for tuberculosis(TB),the costs during treatment impose a significant financial burden on patients and their *** study sought to identify the determinants for cata-strophic costs among patients with drug-sensitive TB(DSTB)and their households in ***::The data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample(n=1071).Treatment related costs and productivity losses were *** costs exceeding 20%of household income were defined as catastrophic and used as the *** Poisson regression analysis was performed to measure the association between selected individual,household and disease characteristics and occurrence of catastrophic costs.A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were ***::The proportion of catastrophic costs among DSTB patients was 27%(n=294).Patients with catastrophic costs had higher median productivity losses,39 h[interquartile range(IQR):20-104],and total median costs of USD 567(IQR:299-1144).The incidence of catastrophic costs had a dose response with household *** poorest quintile was 6.2 times[95%confidence intervals(CI):4.0-9.7]more likely to incur catastrophic costs compared to the *** prevalence of catastrophic costs decreased with increasing household expenditure quintiles(proportion of catastrophic costs:59.7%,32.9%,23.6%,15.9%,and 9.5%)from the lowest quintile(Q1)to the highest quintile(Q5).Other determinants included hospitalization:prevalence ratio(PR)=2.8(95%CI:1.8-4.5)and delayed treatment:PR=1.5(95%CI:1.3-1.7).Protective factors included receiving care at a public health facility:PR=0.8(95%CI:0.6-1.0),and a higher body mass index(BMI):PR=0.97(95%CI:0.96-0.98).Pre TB expenditure,hospitalization and BMI were significant predictors in all sensitivity analysis ***::There are signif

关键词： Tuberculosis Health expenditure Income loss Social protection Kenya

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Community Based Survey Methodology for Maternal Healthcare Utilization: Gujarat, India

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Health 2016年第14期8卷 1542-1553页

作者： Kranti Suresh Vora kristi sidney annerstedt Dileep V. Mavalankar Nishith B. Dholakia Sandul Yasobant Shahin Saiyed Ashish Upadhyay Ayesha De Costa Indian Institute of Public Health Gandhinagar India Public Health Sciences Karolinska Institutet Stockholm Sweden Department of Health & Family Welfare Government of Gujarat Gandhinagar India

Background: About 60% of institutional births occur in the private sector in Gujarat due to limited availability of obstetricians in the government. Chiranjeevi Yojana (CY), a voucher-like program initiated in 2007, accredits private obstetricians who are reimbursed by the state government to provide free delivery care to eligible women i.e. below poverty line and tribal. One million women have delivered under the CY program yet there are no large community based studies of the program. Methodology of a prospective community study is described here. Methods/Designs: A prospective cohort study was done in 142 villages across 3 districts in Gujarat between July, 2013 and November, 2014. A detailed survey was done by trained researchers to ascertain maternal healthcare information including antenatal, intra-partum and post-partum care, place of delivery, birth outcomes, out of pocket expenses etc. Results: 54,955 households were surveyed. 73% of all households had poverty documentation. 4274 mothers who delivered in the study period were included. Discussion: This paper is description of the methodology of a large community based survey and household and individual level characteristics. The survey was nested in a larger project to evaluate the CY program in the state of Gujarat.

关键词： India Demand Side Financing Maternal Morality Chiranjeevi Yojana Community Based Survey

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