A New Financing Model for Tuberculosis (TB) Care in China: Challenges of Policy Development and Lessons Learned from the Implementation

Qian Long, Weixi Jiang, Di Dong, Jiaying Chen, Li Xiang, Qiang Li, Fei Huang, Henry Lucas and Shenglan Tang
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Qian Long: Global Health Research Center, Duke Kunshan University, Suzhou 215316, Jiangsu, China
Weixi Jiang: Global Health Research Center, Duke Kunshan University, Suzhou 215316, Jiangsu, China
Di Dong: Global Health Research Center, Duke Kunshan University, Suzhou 215316, Jiangsu, China
Jiaying Chen: School of Policy & Management, Nanjing Medical University, Nanjing 211166, Jiangsu, China
Li Xiang: Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430074, Hubei, China
Qiang Li: School of Public Health, Xi’an Jiaotong University, Xi’an 710049, Shanxi, China
Fei Huang: National Center for Tuberculosis Control and Prevention, China CDC, Beijing 102206, China
Henry Lucas: Institute of Development Studies, University of Sussex, Brighton BN19RE, UK
Shenglan Tang: Global Health Research Center, Duke Kunshan University, Suzhou 215316, Jiangsu, China

IJERPH, 2020, vol. 17, issue 4, 1-11

Abstract: Background : With support from the Gates Foundation, the Chinese Center for Disease Control and Prevention (China CDC) introduced a new financing model for tuberculosis (TB) care. This paper reviews the development of the associated financing policies and payment methods in three project sites and analyzes the factors impacting on policy implementation and outcomes. Methods : We reviewed policy papers and other relevant documents issued in the project sites. Semi-structured qualitative interviews were conducted with key stakeholders at provincial, city and county levels. Thematic analysis was applied to identify themes and develop interpretations. Results : The China CDC guideline proposed the introduction of a case-based payment based on TB treatment clinical pathways, increased reimbursement rates and financial assistance for the poorest TB patients. Contrary to expectations, TB patients with complications and/or comorbidities were often excluded from the program by hospitals that were concerned the cost of care would exceed the case-based payment ceiling. In addition, doctors frequently prescribed services and/or drugs beyond the coverage of the benefit package for those in the program. Consequently, actual reimbursement rates were low and poor patients still faced a heavy financial burden, though the utilization of services increased, especially by poorer patients. Qualitative interviews revealed three main factors affecting payment policy implementation. They were: hospital managers’ concern on the potential for reduced revenue generation; their fear that patients would regard the service provided as sub-standard if they were not prescribed the full range of available treatments; and a lack of mechanisms to effectively monitor and support the implementation process. Conclusions : While the intervention had some success in improving access to TB care, the challenges of implementing the policy in what proved to be an unreceptive and often antagonistic context resulted in divergences from the original design that frustrated its aim of reducing the financial burden on patients.

Keywords: health financing; TB care; health policy and system research; China (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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