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Comparative Study
. 2019 Mar 24;8(1):21.
doi: 10.1186/s40249-019-0532-x.

Impact of an innovative financing and payment model on tuberculosis patients' financial burden: is tuberculosis care more affordable for the poor?

Wei-Xi Jiang  1 , Qian Long  1 , Henry Lucas  2 , Di Dong  1 , Jia-Ying Chen  3 , Li Xiang  4 , Qiang Li  5 , Fei Huang  6 , Hong Wang  7 , Chris Elbers  8 , Frank Cobelens  9 , Sheng-Lan Tang  10
Affiliations
Comparative Study

Impact of an innovative financing and payment model on tuberculosis patients' financial burden: is tuberculosis care more affordable for the poor?

Wei-Xi Jiang et al. Infect Dis Poverty. .

Abstract

Background: 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 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.

Methods: Three 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.

Results: Data 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.

Conclusions: The 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.

Keywords: Case-based payment; Financing and payment model; Health insurance; Tuberculosis.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval of the study was issued by the Institutional Review Board of Chinese Center for Disease Control and Prevention. Consent form was obtained before individual data collection and could be provided upon request.

Consent for publication

Consent form was obtained before individual data collection and could be provided upon request.

Competing interests

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study design
Fig. 2
Fig. 2
Concentration curve of out-of-pocket health expenditure before and after intervention. formula image OOP: out-of-pocket
See this image and copyright information in PMC

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