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Patients Are Paying Too Much for Tuberculosis: A Direct Cost-Burden Evaluation in Burkina Faso

Author

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  • Samia Laokri
  • Maxime Koiné Drabo
  • Olivier Weil
  • Benoît Kafando
  • Sary Mathurin Dembélé
  • Bruno Dujardin

Abstract

Background: Paying for health care may exclude poor people. Burkina Faso adopted the DOTS strategy implementing “free care” for Tuberculosis (TB) diagnosis and treatment. This should increase universal health coverage and help to overcome social and economic barriers to health access. Methods: Straddling 2007 and 2008, in-depth interviews were conducted over a year among smear-positive pulmonary tuberculosis patients in six rural districts of Burkina Faso. Out-of-pocket expenses (direct costs) associated with TB were collected according to the different stages of their healthcare pathway. Results: Median direct cost associated with TB was US$101 (n = 229) (i.e. 2.8 months of household income). Respectively 72% of patients incurred direct costs during the pre-diagnosis stage (i.e. self-medication, travel, traditional healers' services), 95% during the diagnosis process (i.e. user fees, travel costs to various providers, extra sputum smears microscopy and chest radiology), 68% during the intensive treatment (i.e. medical and travel costs) and 50% during the continuation treatment (i.e. medical and travel costs). For the diagnosis stage, median direct costs already amounted to 35% of overall direct costs. Conclusions: The patient care pathway analysis in rural Burkina Faso showed substantial direct costs and healthcare system delay within a “free care” policy for TB diagnosis and treatment. Whether in terms of redefining the free TB package or rationalizing the care pathway, serious efforts must be undertaken to make “free” health care more affordable for the patients. Locally relevant for TB, this case-study in Burkina Faso has a real potential to document how health programs' weaknesses can be identified and solved.

Suggested Citation

  • Samia Laokri & Maxime Koiné Drabo & Olivier Weil & Benoît Kafando & Sary Mathurin Dembélé & Bruno Dujardin, 2013. "Patients Are Paying Too Much for Tuberculosis: A Direct Cost-Burden Evaluation in Burkina Faso," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-6, February.
    • Handle: RePEc:plo:pone00:0056752
    DOI: 10.1371/journal.pone.0056752
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    References listed on IDEAS

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    1. Samia Laokri & Olivier Weil & Koiné Maxime Drabo & Sary Mathurin Dembelé & Benoît Kafando & Bruno Dujardin, 2013. "Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso," ULB Institutional Repository 2013/153197, ULB -- Universite Libre de Bruxelles.
    2. Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 235-251, April.
    3. Mead, Nicola & Bower, Peter, 2000. "Patient-centredness: a conceptual framework and review of the empirical literature," Social Science & Medicine, Elsevier, vol. 51(7), pages 1087-1110, October.
    4. Ravallion, Martin, 2010. "Poverty lines across the world," Policy Research Working Paper Series 5284, The World Bank.
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    1. Sangsang Qiu & Hongqiu Pan & Simin Zhang & Xianzhen Peng & Xianzhi Zheng & Guisheng Xu & Min Wang & Jianming Wang & Hui Lu, 2015. "Is Tuberculosis Treatment Really Free in China? A Study Comparing Two Areas with Different Management Models," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-13, May.
    2. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    3. Samia Laokri & Arnaud Amoussouhui & Edgard M Ouendo & Athanase Cossi Hounnankan & Séverin Anagonou & Martin Gninafon & Ferdinand Kassa & Léon Tawo & Bruno Dujardin, 2014. "A Care Pathway Analysis of Tuberculosis Patients in Benin: Highlights on Direct Costs and Critical Stages for an Evidence-Based Decision-Making," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-8, May.
    4. Karuna D Sagili & Malaisamy Muniyandi & Kayzad Soli Nilgiriwala & Kalpita S Shringarpure & Srinath Satyanarayana & Richard Kirubakaran & Sarabjit S Chadha & Prathap Tharyan, 2018. "Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-16, October.
    5. Sumedh Bele & Wei Jiang & Hui Lu & Hua You & Hong Fan & Lifang Huang & Qungang Wang & Hongbing Shen & Jianming Wang, 2014. "Population Aging and Migrant Workers: Bottlenecks in Tuberculosis Control in Rural China," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-7, February.

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