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DOTS in China - removing barriers or moving barriers?
1Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China. bxu@shmu.edu.cn
Health Policy and Planning
|August 31, 2006
Summary
China's National TB Control Programme (NTP) aimed to reduce patient costs. However, subsidies shifted expenses to before diagnosis, increasing delays and economic burdens for tuberculosis patients.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Control
Background:
- China's National TB Control Programme (NTP) was revised in 1992 with the Directly Observed Treatment, Short-course (DOTS) strategy.
- Key objectives included reducing patient financial barriers and addressing regressive supplier incentives.
- The study investigates the impact of NTP subsidies on patient expenditure in China's evolving healthcare system.
Purpose of the Study:
- To assess the effectiveness of China's NTP subsidies in removing financial barriers for tuberculosis patients.
- To analyze patient expenditure on medical care and related costs before and after diagnosis.
- To evaluate the influence of market incentive structures on treatment-seeking behavior and delays.
Main Methods:
- A cohort of 493 newly diagnosed tuberculosis patients in 2002 was studied in two counties: Jianhu (with NTP-DOTS) and Funing (initially without).
- A questionnaire-based interview assessed patient expenditure on medical care, transportation, and accommodation.
- Funing implemented NTP-DOTS during the study, allowing for longitudinal and comparative analysis.
Main Results:
- Mean expenditure before diagnosis was higher in Jianhu (715 CNY) than Funing (256 CNY).
- Mean expenditure after diagnosis was higher in Funing (835 CNY) than Jianhu (157 CNY).
- After Funing adopted NTP-DOTS, post-diagnosis expenditure decreased slightly, but pre-diagnosis expenditure increased significantly, indicating a substantial shift.
Conclusions:
- Despite NTP subsidies, tuberculosis patients face a heavy economic burden, with total expenditure reduced only marginally.
- Market incentives in the reformed health system appear to cause delays in diagnosis and treatment.
- The shift in expenditure suggests potential increases in infection transmission due to delayed care.
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