Reducing the financial burden of treating TB: Why is the new funding payment model not effective? Infectious Diseases of Poverty。

Title: Impact of an innovative financing and payment model onculosis patients' financial burden: is tuberculosis care more affordable for the poor?
Journal:
Wei-Xi Jiang, Qian Long, Henry Lucas, Di Dong, Jia-Ying Chen, Li Xiang, Qiang Li, Fei Huang, Hong Wang, Chris Elbers, Frank Cobelens and Sheng-Lan Tang

published time: 24 Mar, 2019
10.1186/s40249-019-0532-
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March 24, 2019 is
, the theme of this year's World Tuberculosis Day is "Don't Wait." The World Health Organization calls on countries to take action to expand access to prevention and treatment services and to actively promote accelerated access to tuberculosis and health care.
On this year's World Tuberculosis Day, an article published by
provides a quantitative and qualitative analysis of the impact on the financial burden of ordinary TB patients, particularly poor patients, by improving the proportion of health insurance reimbursements for TB patients and implementing a new fund-raising payment method that is the main intervention of the pay-per-disease payment method.
is a detailed introduction to this paper., an ancient infectious disease, still requires 6-8 months of treatment to cure, while drug-resistant TB takes longer to treat. As one of the countries with the highest burden of TB diseases in the world, TB prevention and control services have been unified from the CDC/TB Prevention and Control Institute responsible for public health services and clinical treatment model, to the general hospital-based designated medical institutions to provide clinical services, primary township hospitals / community health service centers responsible for patient referral and management, CDC responsible for disease surveillance and other public health work of the "three-in-one" model. Under the new TB prevention and treatment model, TB patients still face a heavy financial burden, despite China's policy of free distribution of first-line anti-TB drugs. Moreover, TB patients are mostly low-income groups, high treatment costs affect treatment compliance is not uncommon, to China to end the TB epidemic, to achieve the 2030 health-related sustainable development goals pose a serious challenge.
In the field of research to reduce the financial burden on TB patients,
recently published an article that, in a combination of quantitative and qualitative, provides a detailed analysis of the impact of new funding payment methods to increase the proportion of medical insurance reimbursement for TB patients and to implement pay-per-disease payments as the main interventions on the financial burden of ordinary TB patients, especially poor patients. The researchers conducted questionnaires for general TB patients and qualitative interviews with patients and medical personnel before and after the implementation of the new fund-raising payment model, and found that the percentage increase in out-of-home medical expenses per patient after the implementation of the new model was significantly higher than that of the richest patients.
qualitative results show that although the new model specifies a standard medical package, hospitals will still provide standard out-of-package services, especially for patients with complications and complications. The increase in the use of out-of-pocket medical services for patients, which cannot be covered by the new funding model, may be the reason for the unabated increase in out-of-pocket costs and financial burdens. The personal income of doctors is also linked to the medical income of the department, and there is an incentive to over-provide medical services.
conclusion of this article, under the background of the current medical system, the income of Clinicians in China is generally related to the income of the department medical business. If all health services are not included in the new funding system, doctors will always be motivated to over-provide care, increasing the financial burden on patients. In addition, the amount strategy of cost control needs to be developed and implemented urgently to improve the effective coverage of basic medical and health services in China.。 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.。 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.。 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.。 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.。 is an open access, peer-reviewed journal publishing topic areas and methods that address essential public health questions relating to infectious diseases of poverty. These include various aspects of the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. Transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology are also considered.
(Source: Science.com)