title: The affordability for patients of a new universal MDR-TB coverage model in China.
abstract: BACKGROUND
  China has piloted a new model of universal coverage for multidrug-resistant tuberculosis (MDR-TB), designed to rationalize hospital use of drugs and tests and move away from fee-for-service payment towards a standard package with financial protection against catastrophic health costs.
  
  
  OBJECTIVE
  To evaluate the affordability to patients of this new model.
  
  
  METHODS
  This was an observational study of 243 MDR-TB cases eligible for enrolment on treatment under the project. We assessed the affordability of the project from the perspective of households, with a focus on catastrophic costs.
  
  
  RESULTS
  Of the 243 eligible cases, 172 (71%) were enrolled on treatment; of the 71 cases not enrolled, 26 (37%) cited economic reasons. The 73 surveyed cases paid an average of RMB 5977 (US$920) out-of-pocket in search costs incurred outside the pilot model. Within the pilot, they paid another RMB 2094 (US$322) in medical fees and RMB 5230 (US$805) in direct non-medical costs. Despite 90% reimbursement of medical fees, 78% of households experienced catastrophic costs, including indirect costs.
  
  
  CONCLUSIONS
  The objectives of the pilot model are aligned with health reform in China and universal health coverage globally. Enrollment would almost certainly be higher with 100% reimbursement of medical fees, but patient enablers will be required to truly eliminate catastrophic costs.
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Y-Z
authors.initials: YZ
authors.lastname: Ruan
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: R-Z
authors.initials: RZ
authors.lastname: Li
authors.affiliation: Chinese Anti-Tuberculosis Association, Beijing, China.
authors.forename: X-X
authors.initials: XX
authors.lastname: Wang
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: L-X
authors.initials: LX
authors.lastname: Wang
authors.affiliation: Center for Health Management and Policy, Shandong University, Jinan, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Sun
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: C-H
authors.initials: CH
authors.lastname: Xu
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: W
authors.initials: W
authors.lastname: Su
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhao
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Pang
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Cheng
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Fu
authors.affiliation: Bill and Melinda Gates Foundation, China Office, Beijing, China.
authors.forename: S-T
authors.initials: ST
authors.lastname: Huan
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: M-T
authors.initials: MT
authors.lastname: Chen
authors.affiliation: World Health Organization, China Office, Beijing, China.
authors.forename: F
authors.initials: F
authors.lastname: Scano
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Floyd
authors.affiliation: Bill and Melinda Gates Foundation, China Office, Beijing, China.
authors.forename: D P
authors.initials: DP
authors.lastname: Chin
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Fitzpatrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002681:China; D003363:Cost Control; D003695:Delivery of Health Care / Q000191:economics* / Q000331:legislation & jurisprudence; D016527:Drug Costs / Q000331:legislation & jurisprudence; D005260:Female; D005382:Financing, Personal / Q000191:economics; D018166:Health Care Reform / Q000191:economics; D005102:Health Expenditures / Q000331:legislation & jurisprudence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000191:economics* / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000331:legislation & jurisprudence; D010865:Pilot Projects; D015397:Program Evaluation; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D019472:Universal Health Insurance / Q000191:economics* / Q000331:legislation & jurisprudence; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents