Are free anti-tuberculosis drugs enough? An empirical study from three cities in China

Abstract

BackgroundTuberculosis (TB) patients in China still face a number of barriers in seeking diagnosis and treatment. There is evidence that the economic burden on TB patients and their households discourages treatment compliance.MethodsA cross-sectional study was conducted in three cities of China. Patients were selected using probability proportional to size (PPS) cluster sampling of rural townships or urban streets, followed by list sampling from a patient register. Data were collected using a questionnaire survey, key informant interviews and focus group discussions with TB patients to gain an understanding of the economic burden of TB and implications of this burden for treatment compliance.ResultsA total of 797 TB patients were surveyed, of which 60 were interviewed in-depth following the survey. More than half had catastrophic health expenditure. TB patients with higher household incomes were less likely to report non-compliance (OR 0.355, 95 % CI 0.140–0.830) and patients who felt that the economic burden relating to TB treatment was high more likely to report non-compliance (OR 3.650, 95 % CI 1.278–12.346). Those who had high costs for transportation, lodging and food were also more likely to report non-compliance (OR 4.150, 95 % CI 1.804–21.999). The findings from the qualitative studies supported those from the survey.ConclusionThe economic burden associated with seeking diagnosis and treatment remains a barrier for TB patients in China. Reducing the cost of treatment and giving patients subsidies for transportation, lodging and food is likely to improve treatment compliance. Improving doctors’ salary system to cut off the revenue-oriented incentive, and expanding current insurance’s coverage can be helpful to reduce patients’ actual burden or anticipated burden. Future research on this issue is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-015-0080-y) contains supplementary material, which is available to authorized users.

How and to What Extent Can Pensions Facilitate Increased Use of Health Services by Older People: Evidence From Social Pension Expansion in Rural China

“…Our ndings indicating that a pension promotes increased use of inpatient services by low-income people is in line with previous evidence, which indicates that the poor are more sensitive to the costs of transportation, subsistence and co-payments [16], and these costs usually impede their access to health services [14][15][16]. In China, these costs of access to inpatient services are typically considerably higher than those for outpatient services.…”

“…Even so, UCTs are preferred by a number of researchers as being able to generate greater behaviour change, given that they are more socially acceptable and less stigmatizing for recipients than CCTs [13]. In addition, existing evidence suggests that universal expansion of health insurance and services might not be su cient to improve the health of the whole population, because the costs of transport, subsistence and co-payments will still impede access to services, especially for the poor [14][15][16]. The exibility of UCT may offset these barriers.…”

“…To date, limited studies have addressed this issue [5,13], with inconsistent results, including negative [18], positive [5,[19][20][21], negligable [12,[22][23][24], or mixed effects [14]. Given that the poor are more sensitive to the costs of transport, subsistence and copayments [16], and thus may bene t more from a UCT, analysis by income group should offer more helpful insights. In this study, we aim to ll this gap in the literature using longitudinal national survey data.…”

Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania

“…Patients experiencing TB symptoms may initially seek relief by using self-prescribed medication or by consulting a health care provider who does not request TB investigations despite repeated visits [5]. The economic burden of seeking care remains a barrier for TB patients [6]. …”

The married middle working class turned out to be the most financially fragile group when facing multidrug-resistant tuberculosis in China cities

“…Despite constant efforts the China Government made in health care measures trying to ease financial difficulties, but many kinds of medicine are not provided free of charge, especially new effective medicines such as linezolid and cycloserine. Many MDR-TB patients reflected that one of the major problems from the illness was still financial hardship [27][28][29] Many studies have proved total cost spent on treating MDR-TB to be catastrophic for patients from most low-and middle-income families [30,31].Surprisingly we found the middle working class were struck the hardest financially. Their relatively high cost of living, with an expensive-to-treat disease left them with a drained disposable household income.…”