Background The problem of AIDS response has not only involved public health, but also had a great impact on the family burden.The objective of this study was to estimate Hunan Province preventive and curative care expenditure(PCE) of AIDS in 2017 based on System of Health Accounts 2011 by quantity,financing scheme,health provider,health function,and to analyse the factors affecting patients' medical burden.
Methods Through stratified multi-stage sampling method, 1336 institutions were surveyed to obtain AIDS prevention and control data, and combined with official data of Hunan Health Statistical Yearbook, Health Financial Yearbook and Government Input Monitoring System to estimate the AIDS PCE under the framework of SHA2011.Univariate analysis and ordered logistic regression were used to evaluate the factors affecting the medical burden of AIDS patients.
Results The AIDS PCE of Hunan in 2017 was 266.67 million, mainly flowed to hospitals and disease prevention and control institutions. The proportions of curative care expenditure(CCE) and prevention expenditure were 51.39%, 48.61% respectively. From the point of view of the allocation of prevention expenditure, AIDS prevention methods were relatively traditional, and oral PrEP was not included in the national plan. All prevention expenditure and 88.52% of CCE were borne by public financing scheme.Family health expenditure accounted for 11.21% of CCE. None insurance, co-infection and length of stay are risk factors to the total expenditure of hospitalization and out-of-pocket health expenditure(all p <0.05,OR>1).Taking the age group under 30 as the reference, the partial regression coefficient of the age group over 60 was statistically significant ( OR (Totalexp) =1.809, OR (OOP) =0.30).
Conclusions The financing structure of the Hunan Province PCE of AIDS was relatively stable and the flow of institutions was reasonable. The functional flow of expenditure embodied the principle of "prevention first". China should incorporate oral PrEP into the national guidelines as soon as possible to improve the allocation efficiency of AIDS prevention resources. Meantime, several measures should be taken to reduce the hospitalization expenses and medical burden of AIDS patients, including adjusting insurance compensation measures, increasing the rate of patients participating in insurance,encouraging commercial insurance to join the AIDS insurance system,and controlling length of stay in hospital.