School of Public Health, Université Libre de Bruxelles, Research Center Health Policy and Systems - International Health, Brussels, Belgium.
PLoS One. 2013;8(2):e56752. doi: 10.1371/journal.pone.0056752. Epub 2013 Feb 25.
Paying for health care may exclude poor people. Burkina Faso adopted the DOTS strategy implementing "free care" for Tuberculosis (TB) diagnosis and treatment. This should increase universal health coverage and help to overcome social and economic barriers to health access.
Straddling 2007 and 2008, in-depth interviews were conducted over a year among smear-positive pulmonary tuberculosis patients in six rural districts of Burkina Faso. Out-of-pocket expenses (direct costs) associated with TB were collected according to the different stages of their healthcare pathway.
Median direct cost associated with TB was US$101 (n = 229) (i.e. 2.8 months of household income). Respectively 72% of patients incurred direct costs during the pre-diagnosis stage (i.e. self-medication, travel, traditional healers' services), 95% during the diagnosis process (i.e. user fees, travel costs to various providers, extra sputum smears microscopy and chest radiology), 68% during the intensive treatment (i.e. medical and travel costs) and 50% during the continuation treatment (i.e. medical and travel costs). For the diagnosis stage, median direct costs already amounted to 35% of overall direct costs.
The patient care pathway analysis in rural Burkina Faso showed substantial direct costs and healthcare system delay within a "free care" policy for TB diagnosis and treatment. Whether in terms of redefining the free TB package or rationalizing the care pathway, serious efforts must be undertaken to make "free" health care more affordable for the patients. Locally relevant for TB, this case-study in Burkina Faso has a real potential to document how health programs' weaknesses can be identified and solved.
医疗付费可能会将贫困人口排除在外。布基纳法索采用了 DOTS 策略，为结核病（TB）的诊断和治疗提供“免费护理”。这应该会增加全民健康覆盖，并有助于克服获得卫生服务的社会和经济障碍。
2007 年至 2008 年期间，在布基纳法索六个农村地区对涂片阳性肺结核患者进行了为期一年的深入访谈。根据他们的医疗保健途径的不同阶段，收集了与结核病相关的自付费用（直接费用）。
与结核病相关的直接费用中位数为 101 美元（n = 229）（即家庭收入的 2.8 个月）。分别有 72%的患者在诊断前阶段（即自我用药、旅行、传统治疗师服务）产生直接费用，95%在诊断过程中（即使用者付费、到各种提供者的旅行费用、额外的痰涂片显微镜检查和胸部 X 光检查），68%在强化治疗期间（即医疗和旅行费用）和 50%在持续治疗期间（即医疗和旅行费用）。对于诊断阶段，直接费用中位数已占总直接费用的 35%。
在结核病“免费护理”政策下，布基纳法索农村地区的患者护理途径分析显示了大量的直接费用和医疗系统延迟。无论是重新定义免费结核病套餐还是合理化护理途径，都必须认真努力，使“免费”医疗更能为患者所负担。就结核病而言，这种在布基纳法索的案例研究具有真正的潜力，可以记录如何识别和解决卫生项目的弱点。
