title: Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China.
abstract: BACKGROUND
  Tuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households. A number of studies have analyzed patient and household expenditure on TB care, but there does not appear to be any that have assessed the incidence, intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China. That will be the objective of this paper.
  
  
  METHODS
  The data used for this study were derived from the baseline survey of the China Government - Gates Foundation TB Phase II program. Our analysis included 747 TB cases. Catastrophic health expenditure for TB care was estimated using two approaches, with households defined as experiencing CHE if their annual expenditure on TB care: (a) exceeded 10 % of total household income; and (b) exceeded 40 % of their non-food expenditure (capacity to pay). Chi-square tests were used to identify associated factors and logistic regression analysis to identify the determinants of CHE.
  
  
  RESULTS
  The incidence of CHE was 66.8 % using the household income measure and 54.7 % using non-food expenditure (capacity to pay). An inverse association was observed between CHE rates and household income level. Significant determinants of CHE were: age, household size, employment status, health insurance status, patient income as a percentage of total household income, hospitalization and status as a minimum living security household. Factors including gender, marital status and type of TB case had no significant associations with CHE.
  
  
  CONCLUSIONS
  Catastrophic health expenditure incidence from TB care is high in China. An integrated policy expanding the free treatment package and ensuring universal coverage, especially the height of UHC for TB patients, is needed. Financial and social protection interventions are essential for identified at-risk groups.
authors.affiliation: Department of Health Service Management and Maternal and Child Health, School of Public Health, Shandong University, Jinan, China. zhouchengchao@sdu.edu.cn.
authors.forename: Chengchao
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA. qian.long@dku.edu.cn.|Global Health Research Center, Duke Kunshan University, Kunshan, China. qian.long@dku.edu.cn.
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.affiliation: School of Health Policy and Management, Nanjing Medical University, Nanjing, China. jychen@njmu.edu.cn.
authors.forename: Jiaying
authors.initials: J
authors.lastname: Chen
authors.affiliation: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China. xllyf@126.com.
authors.forename: Li
authors.initials: L
authors.lastname: Xiang
authors.affiliation: School of Public Health, Xi'an Jiaotong University, Xi'an, China. tjlq@mail.xjtu.edu.cn.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA. shenglan.tang@duke.edu.|Global Health Research Center, Duke Kunshan University, Kunshan, China. shenglan.tang@duke.edu.
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
authors.affiliation: National Center for TB Control and Prevention, China CDC, Beijing, China. huangfei@chinacdc.cn.
authors.forename: Fei
authors.initials: F
authors.lastname: Huang
authors.affiliation: Center for Health Management and Policy, Shandong University, Wen-hua-xi Road No.44, Jinan City, 250012, China. qiangs@sdu.edu.cn.|Key Lab of Health Economic and Policy Studies of Ministry of Health, Jinan, China. qiangs@sdu.edu.cn.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Institute of Development Studies, Sussex University, Brighton, UK. h.lucas@ids.ac.uk.
authors.forename: Henry
authors.initials: H
authors.lastname: Lucas
mesh_terms: D000328:Adult; D000368:Aged; D002388:Catastrophic Illness / Q000191:economics* / Q000628:therapy; D002681:China / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult