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China
Facilitating financing and payment innovations to reduce catastrophic expenditure for TB patients
We work with Chinese partners to develop financing and payment methods that reduce the heavy financial burden on tuberculosis (TB) patients in China and ensure that they receive appropriate and affordable medical treatment.
As a chronic infectious disease, TB, especially multi-drug-resistant TB (MDR-TB), requires a long course of treatment and high medical costs—hardships that, often combined with reduced ability to work, place a heavy burden on patients and their families. The households of Chinese TB patients typically allocate more than 50% of their total income for medical bills. For MDR-TB patients, that figure is 80%. Many MDR-TB patients cannot afford to complete or even to initiate treatment.
Since 2009, in partnership with China’s National Health Commission, we have provided technical and financial support to a TB prevention and control program that works to develop financing and payment methods that relieve the heavy financial burden on TB patients.
Studies show many reasons why medical expenses for TB are so high. A primary factor is insufficient medical insurance coverage, leading to unreimbursed costs for outpatient services or reimbursement for only a tiny portion of outpatient costs. The commonly used pay-for-service model, in which providers are paid for each service performed, also incentivizes hospitals to provide more services, even when they are unnecessary, thereby pushing up medical bills.
From 2009 to 2012, the joint program developed standardized, fixed-price service packages for the diagnosis and treatment of MDR-TB and explored with medical insurance agencies in three prefecture-level cities (Zhenjiang, Yichang, and Hanzhong) the feasibility of a case-based fixed payment model. With subsidies from the program and medical insurance reimbursements, MDR-TB patients’ out-of-pocket expenses were reduced to under RMB 3,000—less than 10% of the total cost.
After this initial success, the program implemented pilot projects from 2013 to 2015 in the same three cities that increased the reimbursement rate for TB patients and expanded the case-based payment model to cover regular TB. We worked with local governments on pooling their funding with money from medical insurance agencies and civil affairs departments. From 2016 to 2019, the program scaled up this financing model to Zhejiang and Jilin provinces, and Ningxia Hui Autonomous Region. Patients paid their medical bills with medical insurance, supplemented by subsidies from civil affairs departments. Local governments covered any gaps in payment. As a result, TB patients paid no more than 30% of their total out-of-pocket medical expenses, while MDR-TB patients paid no more than 10%.
In 2021, the National Healthcare Security Administration (NHSA) and the Ministry of Finance categorized TB as a priority and a chronic outpatient disease and suggested that the reimbursement ratio for TB patients could increase to more than 70%. We are working with the NHSA and the Medical Insurance Research Institute to launch a policy research project and pilot projects on bundled payment methods for TB inpatient and outpatient services. It aims to standardize health services, control medical expenses, and ultimately enable all TB patients in China to receive full medical treatment without financial difficulties.
Learn more about the foundation’s global TB strategy