Abstract
Background: In response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups. Methods: Three sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively. OOP health expenditure and percentage of patients incurring catastrophic health expenditure (CHE) were calculated for different income groups. OLS regression and logit regression were conducted to explore the intervention's impacts on patient OOP health expenditure and financial burden after adjusting for other covariates. Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes. Results: Data from 738 (baseline) and 735 (evaluation) patients were available for analysis. Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791, and the percentage of patients incurring CHE also increased after intervention. The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest. Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden. Conclusions: The implementation of the new financing and payment model did not protect patients, especially those from the lowest income group, from financial difficulty, due partly to their increased use of health service. More financial resources should be mobilized to increase financial protection, particularly for poor patients, while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.
Original language | English |
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Article number | 21 |
Pages (from-to) | 1-10 |
Number of pages | 10 |
Journal | Infectious Diseases of Poverty |
Volume | 8 |
DOIs | |
Publication status | Published - 24 Mar 2019 |
Funding
This paper, as part of the outputs emanating from the program entitled “China National Health and Family Planning Commission and the Gates Foundation TB Project (Phase II)” - a collaboration between the Government of China and the Bill and Melinda Gates Foundation (Grant No. 51914), and implemented by the China Center of Disease Control and Prevention (CDC). The Duke Global Health Institute, USA/Duke Kunshan University in China, Nanjing Medical University, Huazhong University of Science and Technology and Xi’an Jiaotong University in China were contracted by the Foundation and China CDC to undertake the baseline survey and the final evaluation to assess the impact of the comprehensive model of TB/MDRTB control and care in China. Dr. Xiexiu Wang, Dr. Shuigao Jin, Dr. Shiwen Jiang, the three senior advisors of the project, participated in part of the survey and provided very helpful technical supports to the project, to which the authors of the paper are immensely grateful. The authors of the paper would also express their sincere appreciation to Dr. Daniel Chin and Shitong Huan from the Gates Foundation, You Li, Miaomiao Sun from project management office at China CDC, Dr. Zhiying Zhang from PATH, and other colleagues from China CDC at national, provincial, prefectural and county levels, as well as from TB designated hospitals at prefectural and county levels in the three project prefectures who generously contributed their time to the implementation of the study. The whole study was funded by the Bill and Melinda Gates Foundation.
Funders | Funder number |
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Government of China | |
Centers for Disease Control and Prevention | |
Bill and Melinda Gates Foundation | 51914 |
National Health and Family Planning Commission of the People's Republic of China |
Keywords
- Case-based payment
- Financing and payment model
- Health insurance
- Tuberculosis