School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China.
Institute of Development Studies, University of Sussex, Brighton BN1 9RE, UK.
Int J Environ Res Public Health. 2019 Jul 12;16(14):2494. doi: 10.3390/ijerph16142494.
: Tuberculosis (TB) remains a major social and public health problem in China. The "China-Gates TB Project" started in 2012, and one of its objectives was to reduce the financial burden on TB patients and to improve access to quality TB care. The aims of this study were to determine if the project had positive impacts on improving health service utilization. : The 'China-Gates TB Project' was launched in Yichang City (YC), Hubei Province in April 2014 and ended in March 2015, lasting for one year. A series of questionnaire surveys of 540 patients were conducted in three counties of YC at baseline and final evaluations. Inpatient and outpatient service utilization were assessed before and after the program, with descriptive statistics. Propensity score matching was used to evaluate the impact of the China-Gates TB Project on health service utilization by minimizing the differences in the other characteristics of baseline and final stage groups. Focus group discussions (FGDs) were held to further enrich the results. : A total of 530 patients were included in this study. Inpatient rates significantly increased from 33.5% to 75.9% overall ( < 0.001), with the largest increase occurring for low income patients. Outpatient visits increased from 4.6 to 5.6 ( < 0.001), and this increase was also greatest for the poorest patients. Compared with those who lived in developed counties, the overall increase in outpatient visits for illness in the remote Wufeng county was higher. : The China-Gates TB Project has effectively improved health service utilization in YC, and poor patients benefited more from it. TB patients in remote underdeveloped counties are more likely to increase the use of outpatient services rather than inpatient services. There is a need to tilt policy towards the poor, and various measures need to be in place in order to ensure health services utilization in undeveloped areas.
结核病（TB）仍然是中国的一个主要社会和公共卫生问题。“中国盖茨结核病项目”于 2012 年启动，其目标之一是减轻结核病患者的经济负担，改善获得优质结核病护理的机会。本研究旨在确定该项目是否对改善卫生服务利用产生了积极影响。
“中国盖茨结核病项目”于 2014 年 4 月在湖北省宜昌市启动，2015 年 3 月结束，为期一年。在基线和最终评估时，在宜昌市的三个县对 540 名患者进行了一系列问卷调查。在项目前后评估了住院和门诊服务的利用情况，并进行了描述性统计分析。采用倾向评分匹配法，通过最小化基线和最终阶段组其他特征的差异，评估中国盖茨结核病项目对卫生服务利用的影响。同时进行焦点小组讨论（FGD），以进一步丰富研究结果。
本研究共纳入 530 名患者。总体而言，住院率从 33.5%显著增加到 75.9%（<0.001），低收入患者的增幅最大。门诊就诊次数从 4.6 次增加到 5.6 次（<0.001），最贫困的患者增幅最大。与生活在发达县的患者相比，偏远的五峰县的整体门诊就诊次数增加更高。
中国盖茨结核病项目有效地提高了宜昌市的卫生服务利用水平，贫困患者从中受益更多。在偏远欠发达地区，结核病患者更有可能增加门诊服务的使用，而不是住院服务。需要向贫困人口倾斜政策，并采取各种措施确保欠发达地区的卫生服务利用。
