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大多数人可以选择完成整个医疗过程,但我们也因此而付出了很大的经济支出。大部分的病人最终在绝望的情况之下放弃了治疗，社会中有些是直接和间接护理和选择性的借贷来支付保健费用。平均直接和间接成本通常是10%以上，可以高达100%以上的家庭年收入[10]。成本占收入的比例最高的是在较贫困的家庭[11][12]。

Economic support for patients serves a dual purpose: to help overcome economic barriers to use of health services [1], [2], [3], and to mitigate the financial burden of illness and care that can precipitate or worsen poverty [4], [5].

People with TB and/or HIV often experience severe economic barriers to health care in the face of high direct medical costs (consultations, drugs, diagnostics, hospitalization), as well as costs associated with transport, accommodation, food, substitute care, accompaniment and loss of income [6].

Most people who eventually start TB treatment manage to complete the treatment, but many do so at a very high price. A large proportion of patients end up in desperate financial situations as a consequence of both their inability to work due to illness, as well as direct and indirect costs of care and catastrophic borrowing to pay for care. The average total direct and indirect cost is often 10% or more [7], [8], [9] and can be as high as more than 100% of the annual household income [10]. Cost as a percentage of income is highest in poorer households [11], [12]. People with multidrug resistant tuberculosis, face even higher costs than those with drug-susceptible TB, due to longer and more complicated diagnosis and treatment, as well as more severe health conditions [13], [14].

Poor geographical and financial access to health services often prevent or delay health seeking among people with TB, especially the poorest [15]. Moreover, high direct and indirect cost of care constitute important determinants of poor treatment adherence, contributing to low cure rates and high risk of death among poor and vulnerable groups [16], [17]. While there are just a few trials on the impact of economic support on TB detection or treatment adherence, there is some evidence that such interventions, in combination with nutritional support, may improve MDR-TB treatment outcomes [18], [19], [20]. There is also evidence from settings that financial enablers or incentives can help improve uptake and adherence to treatment for latent TB [21], [22], [23].

Similarly, out-of-pocket expenses for the costs of treatment [24], as well as for transport and accommodation are known barriers for poor people to access HIV treatment and care [25], [26], [27], [28], even in middle-income countries [29]. These costs have been shown to affect the uptake of ARV treatment in Malawi [30] and to negatively impact ART adherence in Botswana, Brazil (both prior to free treatment), and Cameroon [31], [32], [33]. Attrition as a result of loss to follow-up is high in low and middle income countries [34], and fees for services (including for monitoring) and transport costs are related to lower retention [35]. Financial factors are also cited in studies of follow-up in prevention-of-mother-to-child-transmissionprograms [36]. Cost for patients of HIV treatment is estimated to correspond to 100% or more of annual income in China, Cote d'Ivoire,本论文由英语论文网提供整理，提供论文代写，英语论文代写，代写论文，代写英语论文，代写留学生论文，代写英文论文，留学生论文代写相关核心关键词搜索。