Abstract
BackgroundIn 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.MethodsThree 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.ResultsData 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.ConclusionsThe 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.
Highlights
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
Previous studies show that over 95% of the Chinese population is covered by the three public health insurance systems – Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI) and New Cooperative Medical Schemes (NCMS) [8] – TB patients bear a high economic burden for medical treatment, especially low-income and rural patients [6, 9,10,11,12]
As a majority of TB patients live in poor households [18, 19], it seems likely that the financial protection provided by the current health insurance schemes is far from sufficient
Summary
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 TB service delivery system in China has been undergoing a transformation whereby responsibility for provision of clinical services is being gradually shifted from TB dispensaries to designated hospitals, typically general hospitals or infectious disease hospitals, in most of the provinces [3]. This transformation has had considerable cost implications, as studies have shown that, while quality of care has often been improved, income-pursuing behaviors, such as over-prescription and unnecessary hospitalization have driven up the treatment cost of TB [4,5,6,7]. As a majority of TB patients live in poor households [18, 19], it seems likely that the financial protection provided by the current health insurance schemes is far from sufficient
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