China News Service, March 24 (Reporter Zhang Ni) March 24 is World Tuberculosis Prevention and Control Day.
According to the "Global Tuberculosis Report 2021" released by the World Health Organization, it is estimated that in 2020, there will be 9.87 million new cases of tuberculosis and 1.5 million deaths from tuberculosis.
In China, although the control of the incidence of tuberculosis has achieved remarkable results, how to reduce the burden of tuberculosis patients with a large base still faces many challenges.
Data map: The opening of the first pediatric tuberculosis clinic in Shenzhen.
Photo courtesy of Shenzhen Third People's Hospital
Over 800,000 new cases a year! Post-resistance patients face a heavy economic burden
As one of the oldest infectious diseases, human beings are still plagued by tuberculosis.
According to the "Global Tuberculosis Report 2021" released by the World Health Organization, tuberculosis still poses a serious threat to global public health.
The number of new cases of tuberculosis in my country is 842,000, ranking second in the world after India.
At the same time, the problem of drug resistance has been highly concerned by experts in the field of public health in recent years.
According to the estimates of the World Health Organization in 2019, there were 66,000 newly diagnosed rifampicin-resistant tuberculosis patients in my country, ranking second in the world.
Drug resistance means longer treatment times, more expensive treatments, and more difficult cures.
Zhang Wenhong, director of the National Center for Infectious Diseases, said in an interview with reporters earlier that China needs to improve the success rate of MDR-TB treatment.
Mao Zongfu, a professor at the School of Public Health of Wuhan University, analyzed to reporters at a recent online seminar on related topics held by the Social Media Center of Peking University. From a macro perspective, there are many reasons for the high burden of tuberculosis in my country, including "countries with high tuberculosis burden". Mainly concentrated in developing countries with a large population base", "unbalanced and insufficient funding", "lack of effective vaccines and insufficient innovation and R&D motivation" and so on.
In addition, the insufficient coverage of basic medical insurance, and the unequal preference of major disease medical insurance and medical assistance policies towards tuberculosis also aggravates the disease burden of patients.
The patient's own age, medication status, occupational and family economic status, whether he can see a doctor in time, compliance, and whether he suffers from complications will also affect the burden of the patient's disease.
Data map: Automatic dispensing system (picture and text irrelevant) Photo by China News Agency reporter Tong Yu
Play "combination punches" in many places to reduce the burden on patients
In fact, my country has been making a lot of efforts and investment in the prevention and control of tuberculosis.
Mao Zongfu once suggested that a number of measures should be coordinated to achieve "zero burden" of MDR-TB.
He introduced that the current state policies such as key transfer payments to key tuberculosis areas in the central and western regions, expansion of the scope of the medical insurance catalog, implementation of drug negotiations, and centralized procurement with volume have further reduced the burden on patients.
In addition to the national level, many localities have also explored unique TB prevention and treatment paths.
For example, Zhejiang is funded by the provincial finance, and tuberculosis is included in the scope of prescribed diseases for urban and rural residents' outpatient clinics; Xinjiang implements 100% reimbursement for pulmonary tuberculosis patients outpatient clinics and 90% hospitalization, and the cost of multidrug resistance treatment is included in the security policy of serious disease planning and medical assistance.
In 2021, Tianjin will speed up the implementation of the hierarchical tuberculosis diagnosis and treatment and comprehensive prevention and control service model, and promote the timeliness and standardization of various tasks such as the detection and treatment of drug-resistant tuberculosis patients.
The Guizhou Provincial Medical Security Bureau also recently made it clear that from April 1, non-drug-resistant active tuberculosis and rifampicin-resistant tuberculosis will be included in the coverage of chronic and special disease outpatient care.
Data map: The registration hall of a hospital.
Photo by Zhang Ni
TB "zero burden" still faces challenges
Reducing the burden does not mean zero burden. According to industry experts, in view of the heavy economic burden of tuberculosis patients, especially drug-resistant tuberculosis patients, medical insurance policies and social security policies still need to be improved, and tuberculosis prevention and control still faces considerable challenges.
Tang Shenglan, Mary & James Semans Chair Professor of Medicine and Global Health, Department of Population Health Sciences, Duke University School of Medicine, believes that although my country's basic medical coverage is very high, there are still many deficiencies in the current policies for the diagnosis and treatment of tuberculosis patients.
First, medical insurance and medical policies are not coordinated, and there is a paradox between the higher threshold for hospitalized patients and the need for hospitalization for tuberculosis patients; second, the social security for tuberculosis is still not perfect.
Chen Jiaying, director of the Center for Health Policy Research at Nanjing Medical University, believes that the current "three-in-one" TB prevention and control model implemented in my country (with designated hospitals as the main body to implement the "prevention, treatment and management" of tuberculosis) is mainly responsible for the diagnosis and treatment of tuberculosis by designated TB hospitals and management, and the current hospital economic compensation model based on medical income will objectively affect their enthusiasm for proactive disease prevention.
Therefore, it is necessary to play a multi-faceted role in the treatment and prevention of tuberculosis, especially the role of medical insurance in motivating hospitals to take the initiative to carry out prevention work.
Faced with the high economic burden of tuberculosis patients, Tang Shenglan suggested that we should further promote multi-channel financing, focus on the actual needs of patients, and improve the level of social security for patients.
In the targeted poverty alleviation project, financial and charitable funds are used to provide timely assistance to patients who have lost their labor force and become impoverished due to illness; for MDR/XDR patients, individualized subsidy programs are formulated on the basis of understanding the actual difficulties of the patients.
Mao Zongfu also believes that the key links affecting the burden of tuberculosis, both socially and personally, are how to reduce the economic burden of the poor so that they can afford treatment; the second is to implement standardized and quality treatment, which is to reduce the burden. key to efficiency.
(over)