Action towards Universal Health Coverage and Social Protection for Tuberculosis Care and Prevention: Workshop on the End TB Strategy Pillar 2 in the Western Pacific Region 2017

Oh, Kyung Hyun; Rahevar, Kalpeshsinh; Nishikiori, Nobuyuki; Viney, Kerri; Choi, Hong-Jo; Biermann, Olivia; Kim, Hee Jin; Nou, Chanly; Kim, Samoeun; Zhu, Ge; Zhang, Hui; Xu, Cheng; Bounmala, Soth; Senchanthixay, Maytry; Purevdorj, Enkhtamir; Khaltar, Ulzii-Orshikh; Paguirigan, Ronald; Amoguis, Hansel; Phu, Vu Xuan; Khang, Dang Xuan

doi:10.3390/tropicalmed4010003

Cited by 8 publications

(8 citation statements)

References 3 publications

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“…Many low-and middle-income countries (including China) aim to provide TB diagnosis and treatment free of charge, however, direct and indirect costs due to TB continue accounting for a high proportion of annual household income of TB patients [8,13,14]. In the past, China has received substantial international assistance in the fight against TB, but now it is essential to mobilize increased domestic resources to improve the accessibility and affordability of high quality TB care.…”

Section: Discussionmentioning

confidence: 99%

A New Financing Model for Tuberculosis (TB) Care in China: Challenges of Policy Development and Lessons Learned from the Implementation

Long

Jiang

Dong

et al. 2020

IJERPH

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Background: With support from the Gates Foundation, the Chinese Center for Disease Control and Prevention (China CDC) introduced a new financing model for tuberculosis (TB) care. This paper reviews the development of the associated financing policies and payment methods in three project sites and analyzes the factors impacting on policy implementation and outcomes. Methods: We reviewed policy papers and other relevant documents issued in the project sites. Semi-structured qualitative interviews were conducted with key stakeholders at provincial, city and county levels. Thematic analysis was applied to identify themes and develop interpretations. Results: The China CDC guideline proposed the introduction of a case-based payment based on TB treatment clinical pathways, increased reimbursement rates and financial assistance for the poorest TB patients. Contrary to expectations, TB patients with complications and/or comorbidities were often excluded from the program by hospitals that were concerned the cost of care would exceed the case-based payment ceiling. In addition, doctors frequently prescribed services and/or drugs beyond the coverage of the benefit package for those in the program. Consequently, actual reimbursement rates were low and poor patients still faced a heavy financial burden, though the utilization of services increased, especially by poorer patients. Qualitative interviews revealed three main factors affecting payment policy implementation. They were: hospital managers’ concern on the potential for reduced revenue generation; their fear that patients would regard the service provided as sub-standard if they were not prescribed the full range of available treatments; and a lack of mechanisms to effectively monitor and support the implementation process. Conclusions: While the intervention had some success in improving access to TB care, the challenges of implementing the policy in what proved to be an unreceptive and often antagonistic context resulted in divergences from the original design that frustrated its aim of reducing the financial burden on patients.

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Section: Discussionmentioning

confidence: 99%

A New Financing Model for Tuberculosis (TB) Care in China: Challenges of Policy Development and Lessons Learned from the Implementation

Long

Jiang

Dong

et al. 2020

IJERPH

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“…A summary of the results from these countries is provided in Figure 2 below; the proportion of TB patients and their households experiencing catastrophic costs ranged from 35% in the Philippines to 70% in Mongolia [2]. The main drivers of these costs vary by country (and even within countries, according to the region or sub-group) [22]. In the Philippines and Vietnam for example, the main drivers of costs were direct non-medical costs and indirect costs, while in Mongolia, direct medical costs and direct non-medical costs were the main drivers of cost for drug-susceptible and drug-resistant TB patients, respectively [22].…”

Section: Costs Of Tb Care In the Western Pacific Regionmentioning

confidence: 99%

The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region

et al. 2019

Self Cite

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The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims to determine the proportion of TB-affected households that incur TB-care related costs equivalent to 20% or more of their annual household income. The target is that zero percentage of TB-affected households will incur catastrophic costs related to TB care by the year 2020. In the Western Pacific Region of the World Health Organization, it is a priority to determine the financial burden of TB and then act to mitigate it. To date, eight countries in the Region have conducted nationally representative TB patient cost surveys to determine the costs of TB care. The results from four countries that have completed these surveys (i.e., Fiji, Mongolia, the Philippines, and Vietnam) indicate that between 35% and 70% of TB patients face catastrophic costs related to their TB care. With these results in mind, significant additional efforts are needed to ensure financial risk protection for TB patients, expand Universal Health Coverage, and improve access to social protection interventions. A multi-sectoral approach is necessary to achieve this ambitious goal by the year 2020.

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“…1,8,9 To close the gap in tuberculosis care coverage, efforts towards achieving universal health coverage (UHC) are vital to ending tuberculosis globally. [10][11][12] However, many low-income and middleincome countries struggle to afford new tools, implement innovations, or adapt their health systems in a way that strengthens tuberculosis control. [13][14][15][16] China has made substantial progress controlling tuberculosis during the past three decades; however, it still has one of the highest burdens of both tuberculosis and multi-drug-resistant tuberculosis in the world.…”

Section: Introductionmentioning

confidence: 99%

Ending tuberculosis in China: health system challenges

Long

Jiang

Huan

et al. 2021

The Lancet Public Health

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China has made remarkable progress in reducing tuberculosis cases and deaths during the past three decades; however, it is still far from achieving the targets set out in the WHO End TB Strategy. Since the 2000s, China has tried to transform its vertical tuberculosis control programme led by the Chinese Center for Disease Control and Prevention (CDC) into an integrated system under the collaboration of CDC, tuberculosis-designated hospitals, and primary health centres. Such a transition has faced many challenges. Profit-driven practices in hospitals designated to tuberculosis and an absence of adequate tuberculosis-related training for health professionals are partially jeopardising the quality of tuberculosis care. In addition, primary health-care providers are not incentivised to make referrals and manage cases effectively. The CDC does not have the administrative power to influence hospital practices or deploy resources to support community-based tuberculosis control activities. Furthermore, an absence of policy coherence and effective coordination causes challenges for quality tuberculosis care that is affordable and accessible. Improving policy dialogues and multi-level coordination within the government is fundamental to successfully ending tuberculosis in China and other countries facing similar challenges.

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Action towards Universal Health Coverage and Social Protection for Tuberculosis Care and Prevention: Workshop on the End TB Strategy Pillar 2 in the Western Pacific Region 2017

Cited by 8 publications

References 3 publications

A New Financing Model for Tuberculosis (TB) Care in China: Challenges of Policy Development and Lessons Learned from the Implementation

A New Financing Model for Tuberculosis (TB) Care in China: Challenges of Policy Development and Lessons Learned from the Implementation

The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region

Ending tuberculosis in China: health system challenges

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