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Is Tuberculosis Treatment Really Free in China? A Study Comparing Two Areas with Different Management Models

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  • Sangsang Qiu
  • Hongqiu Pan
  • Simin Zhang
  • Xianzhen Peng
  • Xianzhi Zheng
  • Guisheng Xu
  • Min Wang
  • Jianming Wang
  • Hui Lu

Abstract

Objective: China has implemented a free-service policy for tuberculosis. However, patients still have to pay a substantial proportion of their annual income for treatment of this disease. This study describes the economic burden on patients with tuberculosis; identifies related factors by comparing two areas with different management models; and provides policy recommendation for tuberculosis control reform in China. Methods: There are three tuberculosis management models in China: the tuberculosis dispensary model, specialist model and integrated model. We selected Zhangjiagang (ZJG) and Taixing (TX) as the study sites, which correspond to areas implementing the integrated model and dispensary model, respectively. Patients diagnosed and treated for tuberculosis since January 2010 were recruited as study subjects. A total of 590 patients (316 patients from ZJG and 274 patients from TX) were interviewed with a response rate of 81%. The economic burden attributed to tuberculosis, including direct costs and indirect costs, was estimated and compared between the two study sites. The Mann-Whitney U Test was used to compare the cost differences between the two groups. Potential factors related to the total out-of-pocket costs were analyzed based on a step-by-step multivariate linear regression model after the logarithmic transformation of the costs. Results: The average (median, interquartile range) total cost was 18793.33 (9965, 3200-24400) CNY for patients in ZJG, which was significantly higher than for patients in TX (mean: 6598.33, median: 2263, interquartile range: 983–6688) (Z = 10.42, P

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  • 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.
    • Handle: RePEc:plo:pone00:0126770
    DOI: 10.1371/journal.pone.0126770
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    Cited by:

    1. Jian Du & Dirlikov Emilio & Yu Pang & Yan Ma & Fengling Mi & Yuhong Liu & Liang Li, 2015. "Tuberculosis Hospitalization Fees and Bed Utilization in China from 1999 to 2009: The Results of a National Survey of Tuberculosis Specialized Hospitals," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-9, October.
    2. Yixiang Huang & Jianying Huang & Xiaoting Su & Liang Chen & Jianwei Guo & Weiqing Chen & Lingling Zhang, 2020. "Analysis of the economic burden of diagnosis and treatment on patients with tuberculosis in Bao’an district of Shenzhen City, China," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-15, August.

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