There is currently no public financial system that fully covers enteric fever suspects in China. This study
aimed at documenting the level of access to definitive diagnostic procedures, especially haemoculture,
for these patients and examining the effect of health insurance on access to such care. A hospital-based
cross-sectional study was conducted in six counties of Yunnan province, using a structured questionnaire
and data extraction from medical records. In total, 714 subjects were recruited. Chi-square test and logistic
regression were employed for analysis of data. The majority of the subjects were young adults (52%)
and farmers (55%) from low-income families (49%). Only 407 (57%) could afford haemoculture routinely
advised by their doctors. Of these, 123 (30%) had haemoculture positive for
Salmonella
Typhi. After adjustment
for income, not getting haemoculture was marginally associated with percentage of reimbursement
from the insurance (p value for trend=0.047). Illiteracy was also an independent risk factor for this outcome.
The poor coverage of haemoculture for patients suspected of having enteric fever in this endemic
area was due to financial barrier. The current health-insurance system inadequately relieved the problem.
Further financial reform to help patients suspected with enteric fever is required.
