Abstract
Objective: The China Center for Disease Control and Prevention (CDC) introduced an innovative financing model of tuberculosis (TB) care and control with the aim of standardizing TB treatment and reducing the financial burden associated with patients with TB. This is a study of the pilot implementation of new financing mechanism in Zhenjiang, between 2014–2015. We compared TB hospitalization rates and inpatient service costs before and after implementation to examine the factors associated with hospital admissions. Our goal is to provide evidence-based recommendations for improving TB service provision and cost control. Methods: We reviewed new policy documents on TB financing. We conducted a patient survey to investigate the utilization of inpatient services, and patients’ out-of-pocket payment for inpatient care. We extracted total medical expenditures of inpatient services from inpatient records of TB designated hospitals. Findings: 63.6% (n = 159) of the surveyed patients with TB were admitted for treatment in 2015, which was higher than that in 2013 (54.8%, n = 144). The number of hospital admission was slightly lower in 2015 (1.16 per patient) than in 2013 (1.26 per patient), while the length of hospital stay was longer in 2015 (24 days) than in 2013 (16 days). In 2015, patients from families with low incomes were more likely to be admitted than those from higher income groups (OR = 3.06, 95% CI: 1.12–8.33). The average inpatient service cost in 2015 (3345 USD) was 1.7 times the cost in 2013 (1952 USD). It was found that 96.2% of patients with TB who were from low-income households spent more than 20% of their household income on inpatient care in 2013, versus 100% in 2015. Conclusion: The TB hospital admission rate and total inpatient service cost increased over the study period. The majority of patients with TB, particularly poor patient who used inpatient care, continue to suffer from heavy financial burden.
Highlights
Tuberculosis (TB) is a chronic communicable disease
The TB hospital admission rate and total inpatient service cost increased over the study period
urban employee basic medical insurance (UEBMI) provided relatively high reimbursement rates for inpatient care, while the reimbursement rates of urban and rural residence basic medical insurance (URRBMI) ranged from 30–75%
Summary
Three counties in Zhenjiang, Dantu, Yangzhong, and Jurong, were selected and included in the preand post-intervention investigations. Cross-sectional TB patient surveys were conducted at pre-intervention in 2013 and post-intervention in 2015. We selected three townships in each county, based on the distance to the county TB designated hospital (far, not far, and close) with the first 90 patients sampled from the list of TB patient registration for both surveys. The inclusion criterion at the baseline was that patients had completed TB treatment before the survey; at the post-intervention survey, the criterion was that patients started and completed treatment during the intervention period. The questionnaire included questions on the general demographic and socio-economic background of the sampled patients, pathways of seeking TB care, and utilization of services and out-of-pocket payment. There were 263 patients in 2013 and 250 in 2015 in the analysis after data cleaning
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