Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a...Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a focus on poor migrants in one district of Shanghai using treatment completion and default rates),the effect of financial incentives in terms of reducing the TB patient cost,and the incremental cost-effectiveness ratio of the intervention.Results:Ninety and ninety-three migrant TB patients were registered in the intervention and control districts respectively.TB treatment completion rates significantly improved by 11%(from 78%to 89%)in the intervention district,compared with only a 3%increase(from 73%to 76%)in the control district(P=0.03).Default rates significantly decreased by 11%(from 22%to 11%)in the intervention district,compared with 1%(from 24%to 23%)in the control district(P=0.03).In the intervention district,the financial subsidy(RMB 1,080/US$170)accounted for 13%of the average patient direct cost(RMB 8,416/US$1,332).Each percent increase in treatment completion costs required an additional RMB 6,550(US$1,301)and each percent reduction in defaults costs required an additional RMB 5,240(US$825)in the intervention district.Conclusions:Overall,financial incentives proved to be effective in improving treatment completion and reducing default rates among migrant TB patients in Shanghai.The results suggest that financial incentives can be effectively utilized as a strategy to enhance case management among migrant TB patients in large cities in China,and this strategy may be applicable to similar international settings.展开更多
基金This study was supported by the Communicable Disease Research Consortium(COMDIS)of the Department for International Development of the UK Government,however,the views expressed in this paper are those of the authors and do not necessarily reflect the opinions of the sponsor.
文摘Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a focus on poor migrants in one district of Shanghai using treatment completion and default rates),the effect of financial incentives in terms of reducing the TB patient cost,and the incremental cost-effectiveness ratio of the intervention.Results:Ninety and ninety-three migrant TB patients were registered in the intervention and control districts respectively.TB treatment completion rates significantly improved by 11%(from 78%to 89%)in the intervention district,compared with only a 3%increase(from 73%to 76%)in the control district(P=0.03).Default rates significantly decreased by 11%(from 22%to 11%)in the intervention district,compared with 1%(from 24%to 23%)in the control district(P=0.03).In the intervention district,the financial subsidy(RMB 1,080/US$170)accounted for 13%of the average patient direct cost(RMB 8,416/US$1,332).Each percent increase in treatment completion costs required an additional RMB 6,550(US$1,301)and each percent reduction in defaults costs required an additional RMB 5,240(US$825)in the intervention district.Conclusions:Overall,financial incentives proved to be effective in improving treatment completion and reducing default rates among migrant TB patients in Shanghai.The results suggest that financial incentives can be effectively utilized as a strategy to enhance case management among migrant TB patients in large cities in China,and this strategy may be applicable to similar international settings.
