Background:China is still faced with the public health challenge of tuberculosis(TB),and a robust surveillance system is critical for developing evidence-based TB control policies.The Tuberculosis Information Manageme...Background:China is still faced with the public health challenge of tuberculosis(TB),and a robust surveillance system is critical for developing evidence-based TB control policies.The Tuberculosis Information Management System(TBIMS),an independent system launched in 2005,has encountered several challenges in meeting the current needs ofTB control.The Chinese government also planned to establish the National Health Information System(NHIS)aggregating data in different areas.The China National Health Commission-Gates TB Project Phase III launched a new TB surveillance system to address these challenges and also as a pilot for the countrywide implementation of the NHIS.This commentary highlights the improvements and challenges in implementing the newTB system and also discusses the implications for the roll-out of the NHIS.展开更多
Background:Tuberculosis(TB)prevalence is closely associated with poverty in China,and poor patients face more barriers to treatment.Using an insurance-based approach,the China-Gates TB program Phase II was implemented...Background:Tuberculosis(TB)prevalence is closely associated with poverty in China,and poor patients face more barriers to treatment.Using an insurance-based approach,the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients,particularly among the poor.This study aims to assess the program effects on service use,and its equity impact across different income groups.Methods:Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively.Inpatient and outpatient service utilization,treatment adherence,and patient satisfaction were assessed before and after the program,across different income groups(extreme poverty,moderate poverty and non-poverty),and in various program cities,using descriptive statistics and multi-variate regression models.Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts.Results:After program implementation,the hospital admission rate increased more for the extreme poverty group(48.5 to 70.7%)and moderate poverty group(45.0 to 68.1%),compared to the non-poverty group(52.9 to 643%).The largest increase in the number of outpatient visits was also for the extreme poverty group(4.6 to 5.7).The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups.Satisfaction rates were high in all groups.Qualitative feedback from stakeholders also suggested that increased reimbursement rates,easier reimbursement procedures,and allowance improved patients'service utilization.Implementation of case-based payment made service provision more compliant to clinical pathways.Conclusion:Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group,indicating improved equity in TB service access.The pro-poor design of the program provides important丨essons to other TB programs in China and other countries to better address TB care for the poor.展开更多
Background:In response to the high financial burden of health services facing tuberculosis(TB)patients in China,the China-Gates TB project,PhaseⅡ,has implemented a new financing and payment model as an important comp...Background:In response to the high financial burden of health services facing tuberculosis(TB)patients in China,the China-Gates TB project,PhaseⅡ,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.Methods: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 Iogit 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.Results: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.Conclusions: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.展开更多
Background:The China National Health Commission-GatesTB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB(DRTB).This study aims ...Background:The China National Health Commission-GatesTB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB(DRTB).This study aims to evaluate the quality of DRTB clinical services and assess the financial burden of DRTB patients during the intervention period.展开更多
Background:Tuberculosis(TB)patient management(TPM)is crucial to improve patient compliance to treatment.The coverage of TPM delivered by TB dispensaries or Centers for Disease Control and Prevention(CDC)was not high u...Background:Tuberculosis(TB)patient management(TPM)is crucial to improve patient compliance to treatment.The coverage of TPM delivered by TB dispensaries or Centers for Disease Control and Prevention(CDC)was not high under the previous CDC model of TB control in China.In the integrated TB control model in China,TB patient management(TPM)was mainly delivered by lay health workers(LHWs)in primary health care(PHC)sectors.This study aims to investigate TPM delivery in resource-limited western China and to identify factors affecting TPM delivery by LHWs under the integrated TB control model.Methods:A stratified random sampling was used to select study sites.Pulmonary TB(PTB)patients≥15 years old from selected counties/districts in Guizhou Province were surveyed from August 2015 to May 2016.Structured questionnaires were used to collect data.Aχ^2 test and logistic regression were used to identify factors associated with self-administered treatment(non-TPM).Results:In total,638 PTB patients were included in the final analysis.Close to 30%of patients were ethnic minorities.More than 30%of patients were from counties with high TB burden,and 24.9%of patients had poor compliance to treatment.Only 37.1%of patients received TPM delivered by LHWs under the integrated TB control model throughout the treatment period.The main reasons for unwillingness to manage reported by patients included social stigma and no perceived need.Being ethnic minorities(OR=3.35)was a main factor associated with lower likelihood of receiving TPM,while living in areas with middle or high TB burden may increase the likelihood of receiving TPM(OR=0.17 and 0.25,respectively).Among current management approaches,more than 85%of patients chose phone reminder as their preferred TPM by LHWs.Conclusions:TPM under the integrated model in West China is still low and need further improvement,and the impeding factors of TPM need to be addressed.Strengthening patient-centered and community-based TPM and developing more feasible approaches of TPM delivery should be explored in future research in this region.展开更多
Background:The End Tuberculosis(TB)Strategy of the World Health Organization highlights the need for patientcentered care and social protection measures that alleviate the financial hardships faced by many TB patients...Background:The End Tuberculosis(TB)Strategy of the World Health Organization highlights the need for patientcentered care and social protection measures that alleviate the financial hardships faced by many TB patients.In China,TB treatments are paid for by earmarked government funds,social health insurance,medical assistance for the poor,and out-of-pocket payments from patients.As part of Phase III of the China-Gates TB project,this paper introduces multi-source financing ofTB treatment in the three provinces of China and analyzes the challenges of moving towards universal coverage and its implications of multi-sectoral engagement for TB care.Main text:The new financing policies forTB treatment in the three provinces include increased reimbursement forTB outpatient care,linkage ofTB treatment with local poverty alleviation programs,and use of local government funds to cover some costs to reduce out-of-pocket expenses.However,there are several challenges in reducing the financial burdens faced byTB patients.First,medical costs must be contained by reducing the profit-maximizing behaviors of hospitals.Second,treatment forTB and multi-drug resistant TB(MDR-TB)is only available at county hospitals and city or provincial hospitals,respectively,and these hospitals have low reimbursement rates and high co-payments.Third,many patients with TB and MDR-TB are at the edge of poverty,and therefore ineligible for medical assistance,which targets extremely poor individuals.In addition,the local governments of less developed provinces often face fiscal difficulties,making it challenging to use of local government funds to provide financial support for TB patients.We suggest that stakeholders at multiple sectors should engage in transparent and responsive communications,coordinate policy developments,and integrate resources to improve the integration of social protection schemes.Conclusions:The Chinese government is examining the establishment of multi-source financing forTB treatment by mobilization of funds from the government and social protection schemes.These efforts require strengthening the cooperation of multiple sectors and improving the accountability of different government agencies.All key stakeholders must take concrete actions in the near future to assure significant progress toward the goal of alleviating the financial burden faced byTB and MDR-TB patients.展开更多
Background:E-learning is a growing phenomenon which provides a unique opportunity to address the challenges in continuing medical education(CME).The China-Gates Foundation Tuberculosis(TB)Control Program implemented o...Background:E-learning is a growing phenomenon which provides a unique opportunity to address the challenges in continuing medical education(CME).The China-Gates Foundation Tuberculosis(TB)Control Program implemented online training forTB health workers in three provinces of China.We aim to evaluate the implementation of E-learning CME programs,analyse the barriers and facilitators during the implementation process,and to provide policy recommendations.展开更多
Background:Given the context of rapid technological cha nge and COIVD-19 pan demies,E-lear ning may provide a unique opportunity for addressing the challenges in traditional face-to-face continuing medical education(C...Background:Given the context of rapid technological cha nge and COIVD-19 pan demies,E-lear ning may provide a unique opportunity for addressing the challenges in traditional face-to-face continuing medical education(CME).However,the effectiveness of E-learning in CME interventions remains unclear.This study aims to evaluate whether E-learning training program can improve TB health personnel's knowledge and behaviour in China.展开更多
Background:The detection of drug-resistant tuberculosis(DR-TB)is a major health concern in China.We aim to summarize interventions related to the screening and detection of DR-TB in Jiangsu Province,analyse their impa...Background:The detection of drug-resistant tuberculosis(DR-TB)is a major health concern in China.We aim to summarize interventions related to the screening and detection of DR-TB in Jiangsu Province,analyse their impact,and highlight policy implications for improving the prevention and control of DR-TB.Methods:We selected six prefectures from south,central and no「th Jiangsu Province.We reviewed policy documents between 2008 and 2019,and extracted routineTB patient registration data from theTB Information Management System(TBIMS)between 2013 and 2019.We used the High-quality Health System Framework to structure the analysis.We performed statistical analysis and logistic regression to assess the impact of different policy interventions on DR-TB detection.Results:Three prefectures in Jiangsu introduced DR-TB related interventions between 2008 and 2010 in partnership with the Global Fund to Fight AIDS,Tuberculosis and Malaria(the Global Fund)and the Bill&Melinda Gates Foundation(Gates Foundation).By 2017,all prefectures in Jiangsu had implemented provincial level DR-TB policies,such as use of rapid molecular tests(RMT),and expanded drug susceptibility testing(DST)for populations at risk of DR-TB.The percentage of pulmonary TB cases con firmed by bacteriology in creased from 30.0%in 2013 to over 50.0%in all prefectures by 2019,indicating that the implementation of new diagnostics has provided more sensitive testing results than the traditional smear microscopy.At the same time,the proportion of bacteriologically confirmed cases tested for drug resistance has increased substantially,indicating that the intervention of expanding the coverage of DST has reached more of the population at risk of DR-TB.Prefectures that implemented interventions with support from the Global Fund and the Gates Foundation had better detection performance of DR-TB patiens compared to those did not receive external support.However,the disparities in DR-TB detection across prefectures significantly narrowed after the implementation of provincial DR-TB polices.Con elusions:The introduction of new diagnostics,including RMT,have improved the detection of DR-TB.Prefectures that received support from the Global Fund and the Gates Foundation had better detection of DR-TB.Additionally,the implementation of provincial DR-TB polices led to improvements in the detection of DR-TB across all prefectures.展开更多
文摘Background:China is still faced with the public health challenge of tuberculosis(TB),and a robust surveillance system is critical for developing evidence-based TB control policies.The Tuberculosis Information Management System(TBIMS),an independent system launched in 2005,has encountered several challenges in meeting the current needs ofTB control.The Chinese government also planned to establish the National Health Information System(NHIS)aggregating data in different areas.The China National Health Commission-Gates TB Project Phase III launched a new TB surveillance system to address these challenges and also as a pilot for the countrywide implementation of the NHIS.This commentary highlights the improvements and challenges in implementing the newTB system and also discusses the implications for the roll-out of the NHIS.
文摘Background:Tuberculosis(TB)prevalence is closely associated with poverty in China,and poor patients face more barriers to treatment.Using an insurance-based approach,the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients,particularly among the poor.This study aims to assess the program effects on service use,and its equity impact across different income groups.Methods:Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively.Inpatient and outpatient service utilization,treatment adherence,and patient satisfaction were assessed before and after the program,across different income groups(extreme poverty,moderate poverty and non-poverty),and in various program cities,using descriptive statistics and multi-variate regression models.Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts.Results:After program implementation,the hospital admission rate increased more for the extreme poverty group(48.5 to 70.7%)and moderate poverty group(45.0 to 68.1%),compared to the non-poverty group(52.9 to 643%).The largest increase in the number of outpatient visits was also for the extreme poverty group(4.6 to 5.7).The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups.Satisfaction rates were high in all groups.Qualitative feedback from stakeholders also suggested that increased reimbursement rates,easier reimbursement procedures,and allowance improved patients'service utilization.Implementation of case-based payment made service provision more compliant to clinical pathways.Conclusion:Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group,indicating improved equity in TB service access.The pro-poor design of the program provides important丨essons to other TB programs in China and other countries to better address TB care for the poor.
基金The whole study was funded by the Bill and Melinda Gates Foundation.
文摘Background:In response to the high financial burden of health services facing tuberculosis(TB)patients in China,the China-Gates TB project,PhaseⅡ,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.Methods: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 Iogit 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.Results: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.Conclusions: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.
文摘Background:The China National Health Commission-GatesTB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB(DRTB).This study aims to evaluate the quality of DRTB clinical services and assess the financial burden of DRTB patients during the intervention period.
基金the National Natural Science Foundation of China(No.81773489)Social Science and Technology Innovation Subject in Chongqing(No.cstc2015shmszx120070)+1 种基金the Technology Basic and Advanced Research Projeas in Chongqing(No.cstc2014jcyjA10069)the Project from Health and Family Planning Commission of Guizhou Province(No.gzwjkj2015-1-079).
文摘Background:Tuberculosis(TB)patient management(TPM)is crucial to improve patient compliance to treatment.The coverage of TPM delivered by TB dispensaries or Centers for Disease Control and Prevention(CDC)was not high under the previous CDC model of TB control in China.In the integrated TB control model in China,TB patient management(TPM)was mainly delivered by lay health workers(LHWs)in primary health care(PHC)sectors.This study aims to investigate TPM delivery in resource-limited western China and to identify factors affecting TPM delivery by LHWs under the integrated TB control model.Methods:A stratified random sampling was used to select study sites.Pulmonary TB(PTB)patients≥15 years old from selected counties/districts in Guizhou Province were surveyed from August 2015 to May 2016.Structured questionnaires were used to collect data.Aχ^2 test and logistic regression were used to identify factors associated with self-administered treatment(non-TPM).Results:In total,638 PTB patients were included in the final analysis.Close to 30%of patients were ethnic minorities.More than 30%of patients were from counties with high TB burden,and 24.9%of patients had poor compliance to treatment.Only 37.1%of patients received TPM delivered by LHWs under the integrated TB control model throughout the treatment period.The main reasons for unwillingness to manage reported by patients included social stigma and no perceived need.Being ethnic minorities(OR=3.35)was a main factor associated with lower likelihood of receiving TPM,while living in areas with middle or high TB burden may increase the likelihood of receiving TPM(OR=0.17 and 0.25,respectively).Among current management approaches,more than 85%of patients chose phone reminder as their preferred TPM by LHWs.Conclusions:TPM under the integrated model in West China is still low and need further improvement,and the impeding factors of TPM need to be addressed.Strengthening patient-centered and community-based TPM and developing more feasible approaches of TPM delivery should be explored in future research in this region.
基金supported by the Bill and Melinda Gates Foundation[Grant No.OPP1137180]。
文摘Background:The End Tuberculosis(TB)Strategy of the World Health Organization highlights the need for patientcentered care and social protection measures that alleviate the financial hardships faced by many TB patients.In China,TB treatments are paid for by earmarked government funds,social health insurance,medical assistance for the poor,and out-of-pocket payments from patients.As part of Phase III of the China-Gates TB project,this paper introduces multi-source financing ofTB treatment in the three provinces of China and analyzes the challenges of moving towards universal coverage and its implications of multi-sectoral engagement for TB care.Main text:The new financing policies forTB treatment in the three provinces include increased reimbursement forTB outpatient care,linkage ofTB treatment with local poverty alleviation programs,and use of local government funds to cover some costs to reduce out-of-pocket expenses.However,there are several challenges in reducing the financial burdens faced byTB patients.First,medical costs must be contained by reducing the profit-maximizing behaviors of hospitals.Second,treatment forTB and multi-drug resistant TB(MDR-TB)is only available at county hospitals and city or provincial hospitals,respectively,and these hospitals have low reimbursement rates and high co-payments.Third,many patients with TB and MDR-TB are at the edge of poverty,and therefore ineligible for medical assistance,which targets extremely poor individuals.In addition,the local governments of less developed provinces often face fiscal difficulties,making it challenging to use of local government funds to provide financial support for TB patients.We suggest that stakeholders at multiple sectors should engage in transparent and responsive communications,coordinate policy developments,and integrate resources to improve the integration of social protection schemes.Conclusions:The Chinese government is examining the establishment of multi-source financing forTB treatment by mobilization of funds from the government and social protection schemes.These efforts require strengthening the cooperation of multiple sectors and improving the accountability of different government agencies.All key stakeholders must take concrete actions in the near future to assure significant progress toward the goal of alleviating the financial burden faced byTB and MDR-TB patients.
文摘Background:E-learning is a growing phenomenon which provides a unique opportunity to address the challenges in continuing medical education(CME).The China-Gates Foundation Tuberculosis(TB)Control Program implemented online training forTB health workers in three provinces of China.We aim to evaluate the implementation of E-learning CME programs,analyse the barriers and facilitators during the implementation process,and to provide policy recommendations.
文摘Background:Given the context of rapid technological cha nge and COIVD-19 pan demies,E-lear ning may provide a unique opportunity for addressing the challenges in traditional face-to-face continuing medical education(CME).However,the effectiveness of E-learning in CME interventions remains unclear.This study aims to evaluate whether E-learning training program can improve TB health personnel's knowledge and behaviour in China.
基金The study was partially funded by a research grant from Jiangsu Provincial Health Commissi on to support the tale nted researchers in the health sector.Dr.Xiao-Yan Ding,supported by the Jiangsu Health International Exchange Program,was a visiting fellow at Duke Global Health Institute,when she was working on this manuscript.
文摘Background:The detection of drug-resistant tuberculosis(DR-TB)is a major health concern in China.We aim to summarize interventions related to the screening and detection of DR-TB in Jiangsu Province,analyse their impact,and highlight policy implications for improving the prevention and control of DR-TB.Methods:We selected six prefectures from south,central and no「th Jiangsu Province.We reviewed policy documents between 2008 and 2019,and extracted routineTB patient registration data from theTB Information Management System(TBIMS)between 2013 and 2019.We used the High-quality Health System Framework to structure the analysis.We performed statistical analysis and logistic regression to assess the impact of different policy interventions on DR-TB detection.Results:Three prefectures in Jiangsu introduced DR-TB related interventions between 2008 and 2010 in partnership with the Global Fund to Fight AIDS,Tuberculosis and Malaria(the Global Fund)and the Bill&Melinda Gates Foundation(Gates Foundation).By 2017,all prefectures in Jiangsu had implemented provincial level DR-TB policies,such as use of rapid molecular tests(RMT),and expanded drug susceptibility testing(DST)for populations at risk of DR-TB.The percentage of pulmonary TB cases con firmed by bacteriology in creased from 30.0%in 2013 to over 50.0%in all prefectures by 2019,indicating that the implementation of new diagnostics has provided more sensitive testing results than the traditional smear microscopy.At the same time,the proportion of bacteriologically confirmed cases tested for drug resistance has increased substantially,indicating that the intervention of expanding the coverage of DST has reached more of the population at risk of DR-TB.Prefectures that implemented interventions with support from the Global Fund and the Gates Foundation had better detection performance of DR-TB patiens compared to those did not receive external support.However,the disparities in DR-TB detection across prefectures significantly narrowed after the implementation of provincial DR-TB polices.Con elusions:The introduction of new diagnostics,including RMT,have improved the detection of DR-TB.Prefectures that received support from the Global Fund and the Gates Foundation had better detection of DR-TB.Additionally,the implementation of provincial DR-TB polices led to improvements in the detection of DR-TB across all prefectures.
