How affordable are tuberculosis diagnosis and treatment in rural China? An analysis from community and tuberculosis patient perspectives

To assess equity in access to tuberculosis (TB) care by estimating and comparing the direct household costs perceived by community residents with actual costs experienced by TB patients and to identify the factors influencing the financial burden of TB patients. Economic study in four provinces of China by means of a survey of 889 TB patients and 2560 community residents and in-depth interviews with key informants. The direct household costs for using TB health services perceived by the communities were two to five times higher than the actual costs incurred by the TB patients. Patients had to pay a substantial proportion of their annual income for TB services (12-40%), despite the fact that smear-positive and some severe smear-negative patients received free drugs. Repeated outpatient visits before diagnosis, over-prescription of drugs and prolonged treatments were common. The heavy financial burden (both perceived and real) on these patients is one of the main reasons that some TB patients fail to access and complete treatment. Pressure to generate revenue through current incentives in health-care financing and poor competence of health workers at the village and township levels cause delay and high expenses to TB patients and ultimately impede effective TB control in China.