Abstract
BackgroundTuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment. Using an insurance-based approach, the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients, particularly among the poor. This study aims to assess the program effects on service use, and its equity impact across different income groups.MethodsData from 788 and 775 patients at baseline and final evaluation were available for analysis respectively. Inpatient and outpatient service utilization, treatment adherence, and patient satisfaction were assessed before and after the program, across different income groups (extreme poverty, moderate poverty and non-poverty), and in various program cities, using descriptive statistics and multi-variate regression models. Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts.ResultsAfter program implementation, the hospital admission rate increased more for the extreme poverty group (48.5 to 70.7%) and moderate poverty group (45.0 to 68.1%), compared to the non-poverty group (52.9 to 64.3%). The largest increase in the number of outpatient visits was also for the extreme poverty group (4.6 to 5.7). The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups. Satisfaction rates were high in all groups. Qualitative feedback from stakeholders also suggested that increased reimbursement rates, easier reimbursement procedures, and allowance improved patients’ service utilization. Implementation of case-based payment made service provision more compliant to clinical pathways.ConclusionPatients in extreme or moderate poverty benefited more from the program compared to a non-poverty group, indicating improved equity in TB service access. The pro-poor design of the program provides important lessons to other TB programs in China and other countries to better address TB care for the poor.
Highlights
Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment
A national survey in 2010 indicated that 10% of TB patients had intermittent treatment, and another 22% terminated before completing treatment. 15% of patients who terminated treatment reported that financial difficulties were the cause for their poor adherence [1]
This study aims to address this issue by considering the impact of the China-Gates TB program (Phase II) on service utilization, treatment adherence and patient satisfaction across three income groups identified as consisting of those living in: extreme poverty, moderate poverty and non-poverty
Summary
Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment. Tuberculosis (TB) prevalence is closely associated with poverty in China. Low-income TB patients in China face greater financial barriers to quality treatment and have lower treatment adherence [3, 4]. 15% of patients who terminated treatment reported that financial difficulties were the cause for their poor adherence [1]. The overall cost of TB treatment is substantial, and poor TB patients are more likely to have catastrophic health expenditure. A study in three cities in China found that over 94% of households in the poorest quintile, compared to 43% in the richest quintile, had catastrophic expenditure due to TB treatment [4]
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