Despite global efforts to end tuberculosis (TB), the goal of preventing catastrophic health expenditure (CHE) due to TB remains unmet. This cross-sectional study was conducted in Guizhou Province, Southwest China. Data were collected from the Hospital Information System and a survey of TB patients who had completed standardized antituberculosis treatment between January and March 2021. Among the 2 283 participants, the average total expenditure and out-of-pocket expenditure were $1 506.6 (median = $760.5) and $683.6 (median = $437.8), respectively. Health insurance reimbursement reduced CHE by 16.8%, with a contribution rate of 24.9%, and the concentration index changed from -0.070 prereimbursement to -0.099 postreimbursement. However, the contribution of health insurance varied significantly across different economic strata, with contribution rates of 6.4% for the lowest economic group and 53.1% for the highest group. For patients from lower socioeconomic strata, health insurance contributed 10.7% to CHE in the prediagnostic phase and 23.5% during treatment. While social health insurance alleviated the financial burden for TB patients, it did not provide sufficient protection for those in lower economic strata or during the prediagnostic stage. This study underscores the need for more effective and equitable subsidy policies for TB patients .