Revenue-driven in TB control--three cases in China

Area of Science:

• Public Health
• Health Economics
• Tuberculosis Control

Background:

• China faces a significant burden of tuberculosis (TB) cases, with a quarter of all global cases originating there.
• The country has transitioned to a socialist market economy, influencing healthcare financing, with user payments forming a substantial portion.

Purpose of the Study:

• To examine driving forces for TB program performance under different financing models.
• To understand the impact of user payments on case detection, management, and patient costs in TB control.

Main Methods:

• A case study approach was employed to analyze three distinct TB programs in China.
• These programs represented different user payment models: free service, subsidized service, and full cost recovery.

Main Results:

• All analyzed TB control models adapted strategies to maximize provider income.
• This income-driven approach resulted in reduced case detection, unnecessary procedures/drugs, and increased patient costs, potentially excluding vulnerable populations.
• Programmatic adaptations prioritized income generation over optimal patient care and detection.

Conclusions:

• User charges in TB control programs can incentivize performance but require careful design to avoid negative consequences.
• Restructuring referral systems is crucial to eliminate disincentives for good practices within TB control.
• Future TB control programs in market-oriented economies must align financial incentives with public health goals to ensure equitable access and effective treatment.