March 24, 2022 is the 27th World Tuberculosis Prevention and Control Day, and the World Health Organization has set the theme of “Life First, Dedicated to End Tuberculosis” as the publicity theme of Tuberculosis Day. At present, tuberculosis is still one of the deadliest infectious diseases in the world, with nearly 30,000 new cases and about 4,100 deaths from tuberculosis every day in the world. According to data from the Beijing Center for Disease Control and Prevention, in 2021, Beijing will report 6,717 cases of pulmonary tuberculosis, with a reported incidence rate of 30.7/100,000, which is one of the lowest levels of tuberculosis in the country. 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.
The 13th leading cause of death in the world
March 24 marks the 27th World Tuberculosis Day. Historically, tuberculosis, once known as the “white plague”, is one of the oldest infectious diseases. According to a 2019 data from the World Health Organization, tuberculosis is the 13th leading cause of death globally and the leading cause of death from a single infectious disease.
According to the estimates of the World Health Organization in 2019, there were 66,000 new cases of rifampicin-resistant tuberculosis in my country, ranking second in the world. According to Shenglan Tang, Mary & James Semans Chair Professor of Medicine and Global Health in the Department of Population Health Sciences at Duke University School of Medicine, drug resistance means longer treatment times, higher treatment costs, and more difficulty in curing the disease. In terms of catastrophic expenditure on medical and health care households caused by tuberculosis, China is still a country with a high burden, and catastrophic expenditures account for 19.72% of the total sick population.
The country has done a lot of work in tuberculosis prevention and control. Tang Shenglan said that at present, the coverage of basic medical insurance in China is very high, perhaps more than 96%, and medical insurance basically covers tuberculosis patients. In addition, medical insurance also has preferential policies for tuberculosis. The basic medical insurance of residents in provinces and cities includes tuberculosis in outpatient chronic and special diseases, and the reimbursement ratio reaches 60%-70%. Multidrug resistance/extensive drug resistance is included in outpatient serious diseases, and the reimbursement ratio is the same as Hospitalizations were flat.
Many places have also explored different ways to prevent and treat tuberculosis. Mao Zongfu, a professor at the School of Public Health of Wuhan University and director of the Wuhan University Global Health Research Center, said that in Jiangsu Province, 40 million yuan will be invested in the prevention and treatment of MDR-TB in 2020, of which 20 million will be subsidized drugs. Second-line drugs such as moxifloxacin, levofloxacin, cycloserine, clofazimine, prothionamide and bedaquiline are provided free of charge to patients.
With the efforts of the state, the prevention and control of tuberculosis has achieved certain results. According to data from the Beijing Center for Disease Control and Prevention, in 2021, Beijing will report 6,717 cases of pulmonary tuberculosis, with a reported incidence rate of 30.7/100,000, which is one of the lowest levels of tuberculosis in the country. In addition, Hunan reported 49,250 new cases in 2021, a decrease of 6.3% from 2020.
Ending tuberculosis still requires efforts from multiple parties
In the opinion of industry experts, medical insurance policies and social security policies are still in There is still room for improvement, and tuberculosis prevention and control still faces many challenges.
Tang Shenglan 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, Nanjing Medical University, believes that the “three-in-one” tuberculosis prevention and control model currently implemented in my country (with designated hospitals as the main body to implement the integration of tuberculosis prevention, treatment and management), is mainly composed of tuberculosis designated hospitals Hospitals are responsible for the diagnosis, treatment and management of tuberculosis, and the current hospital economic compensation model, which is mainly 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 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; This is a key link in reducing burden and increasing efficiency.
Beijing Centers for Disease Control and Prevention reminded to maintain vigilance against tuberculosis, understand the harm of tuberculosis, master the knowledge and skills of daily prevention and control; develop good hygiene habits, and wear masks when going to crowded places. Time to stay in a closed, crowded, poorly ventilated environment, away from people who cough frequently. At the same time, it is necessary to do a good job of personal health monitoring. When coughing, expectoration of sputum for 2 weeks or more, or suspicious symptoms of pulmonary tuberculosis such as blood in the sputum, it is necessary to seek medical treatment in time to avoid delaying the treatment. When diagnosed with tuberculosis, they should actively cooperate with treatment and related management, and do a good job in infection control to avoid infecting others. Beijing Business Daily reporter Yao Qian