Chongqing Medical University, Chongqing, China.
Trop Med Int Health. 2010 Jan;15(1):26-32. doi: 10.1111/j.1365-3156.2009.02427.x. Epub 2009 Nov 16.
To measure patient expenditure on additional drugs and tests in public services where tuberculosis (TB) drugs are supplied for free.
Questionnaire survey of patients currently on treatment in eight TB dispensaries in two provinces; in depth interviews with providers at the facilities.
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.
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.
测量在免费供应结核病（TB）药物的公共服务中，患者在额外药物和检查上的支出。
对两省 8 个结核病诊疗所中正在接受治疗的患者进行问卷调查；对机构中的提供者进行深入访谈。
为 86%的患者开具了护肝药物（141/163），93%的患者在上个月进行了一项或多项检查，23%的患者治疗时间超过世界卫生组织推荐的治疗时间。除了两名患者，每位患者每次就诊都要以现金支付一些费用：在上个月平均为 287 元人民币（40 美元）。对于贫困线以下的患者，药物和检查支出是其平均家庭月收入的 1.85 倍。不同收入群体之间的平均费用差异不大。就开具的抗结核药物而言，17.8%的方案不符合国际标准。提供者报告说，他们开护肝药物是为了避免医疗疏忽，他们认为这些药物是有效的；而且，政府对提供结核病治疗的补贴根本不够。
尽管中国表面上有一个完全补贴的结核病计划，但无论收入如何，患者都要支付大量费用。需要进行研究以确认这些做法的广泛存在，但这需要与融资策略相结合来解决这个问题。
