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

作　　者：Wei-Xi Jiang Qian Long Henry Lucas Di Dong Jia-Ying Chen Li Xiang Qiang Li Fei Huang Hong Wang Chris Elbers Frank Cobelens Sheng-Lan Tang 

机构地区：[1]Global Health Research Center,Duke Kunshan University,Kunshan 215316,Jiangsu,China [2]Institute of Development Studies,University of Sussex,Brighton BN19RE,UK [3]School of Policy&Management,Nanjing Medical University,Nanjing 211166,Jiangsu,China [4]Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,Hubei,China [5]School of Public Health,Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China [6]National Center for Tuberculosis Control and Prevention,China CDC,Beijing 102206,China [7]Bill&Melinda Gates Foundation,Seattle,WA,USA [8]Faculty of Economics and Business Administration,Vrije Universiteit Amsterdam,Amsterdam 1081,HV,the Netherlands [9]The Amsterdam Institute for Global Health and Development,Amsterdam 1105,BP,the Netherlands [10]Duke Global Health Institute,Duke University,Durham,NC 27710,USA

出　　处：《Infectious Diseases of Poverty》2019年第2期43-52,共10页贫困所致传染病（英文）

基　　金：The whole study was funded by the Bill and Melinda Gates Foundation.

摘　　要：Background:In response to the high financial burden of health services facing tuberculosis(TB)patients in China,the China-Gates TB project,PhaseⅡ,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 Iogit 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

关 键 词：Health INSURANCE TUBERCULOSIS FINANCING and PAYMENT model Case-based PAYMENT 

分 类 号：TP3[自动化与计算机技术—计算机科学与技术]