title: The impact of the new cooperative medical scheme on financial burden of tuberculosis patients: evidence from six counties in China.
abstract: BACKGROUND
  Tuberculosis (TB) patients in China encounter heavy financial burdens throughout the course of their treatment and it is unclear how China's health insurance systems affect the alleviation of this burden under the integrated approach. This study aimed to measure reimbursement for TB services under the New Cooperative Medical Scheme (NCMS) in rural China and to evaluate changes in catastrophic health expenditure (CHE) caused by the reimbursement policies.
  
  
  METHODS
  Reimbursement data were obtained from routine data systems for the NCMS in Yichang (YC) and Hanzhong (HZ). 1884 TB inpatients reimbursed by NCMS from 2010 to 2012 were included. Household surveys were conducted. A total of 494 TB patients under the NCMS were selected in this paper. 12 Focus Group Discussions (FGDs) were held. We measured the impact of the NCMS by counterfactual analysis, which analyzed the financial burden alleviation. Equity was assessed by Concentration Index (CI), and disaggregated by project sites.
  
  
  RESULTS
  TB inpatients were reimbursed with an effective reimbursement rate of 57.3 %. Average out-of-pocket (OOP) payments for outpatient and inpatient services after diagnosis were 1413 yuan and 430 yuan, and 3572 yuan and 3013 yuan in YC and HZ, respectively. The reimbursement level for TB outpatient care after diagnosis was very low due to a limited outpatient quota. TB patients in HZ incurred higher effective reimbursement rates, but the incidence of CHE remained higher. The reduction of CHE incidence after the NCMS showed no difference statistically (P > 0.05). The severity of CHE was alleviated slightly. CIs after reimbursement were all below zero and their absolute values were higher than those before reimbursement.
  
  
  CONCLUSIONS
  Low reimbursement for TB patients could lead to heavy financial burden. Poor TB patients incurred high rates of CHE. The NCMS was found to be a protective factor for CHE, but the impact was modest and the equity of CHE did not improve. The NCMS reimbursement policies should be improved in the future to include a more comprehensive coverage of care. Supplemental programs may be necessary to expand coverage for TB care.
authors.affiliation: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China. xllyf@126.com.
authors.forename: Li
authors.initials: L
authors.lastname: Xiang
authors.affiliation: The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. panyao0301@163.com.
authors.forename: Yao
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Hubei Provincial Center for Disease Control and Prevention, Wuhan, China. 412106911@qq.com.
authors.forename: Shuangyi
authors.initials: S
authors.lastname: Hou
authors.affiliation: Shaanxi Provincial Institute for TB Control and Prevention, Xi'an, China. zhhwfzhk@126.com.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA. kaori.sato@duke.edu.
authors.forename: Kaori D
authors.initials: KD
authors.lastname: Sato
authors.affiliation: School of Public Health, Xi'an Jiaotong University, Xi'an, China. tjlq@mail.xjtu.edu.cn.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China. jingwang@hust.edu.cn.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA. shenglan.tang@duke.edu.|Global Health Research Center, Duke Kunshan University, Kunshan, China. shenglan.tang@duke.edu.
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D002388:Catastrophic Illness / Q000191:economics; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
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