title: Tuberculosis patient expenditure on drugs and tests in subsidised, public services in China: a descriptive study.
abstract: OBJECTIVE
  To measure patient expenditure on additional drugs and tests in public services where tuberculosis (TB) drugs are supplied for free.
  
  
  METHODS
  Questionnaire survey of patients currently on treatment in eight TB dispensaries in two provinces; in depth interviews with providers at the facilities.
  
  
  RESULTS
  Liver protection drugs (141/163) were prescribed for 86% of patients, 93% had one or more tests in the last month, and 23% were on treatment past the World Health Organization-recommended treatment duration. All but two patients were charged for something in cash at each visit: on average 287 Chinese Yuan (40 US dollars) in the previous month. For patients below the poverty line, drug and test expenditure was 1.85 times their average household monthly income. Average charges varied little between income categories. In terms of anti-TB drugs prescribed, 17.8% of regimens were inadequate by international standards. Providers reported they prescribe liver protection drugs to avoid medical negligence, and they believed they were effective; and the government subsidy for providing TB treatment was simply not enough.
  
  
  CONCLUSIONS
  Despite an ostensibly fully subsidised TB programme in China, patients are charged substantive amounts irrespective of income. Research is needed to confirm these practices are widespread but this needs to be coupled with financing strategies to tackle it.
authors.affiliation: Chongqing Medical University, Chongqing, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Liu
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
authors.forename: Qingliang
authors.initials: Q
authors.lastname: Wang
authors.forename: Paul
authors.initials: P
authors.lastname: Garner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000191:economics* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D056486:Chemical and Drug Induced Liver Injury / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D002681:China; D017281:Cost of Illness; D003955:Diagnostic Tests, Routine / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005380:Financing, Government / Q000706:statistics & numerical data; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008318:Malpractice / Q000191:economics; D008875:Middle Aged; D011634:Public Health / Q000191:economics; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents