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首页> 外文期刊>Health policy and planning >DOTS in China - removing barriers or moving barriers?
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DOTS in China - removing barriers or moving barriers?

机译：中国的DOTS-消除障碍还是消除障碍？

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In 1992, China initiated its modern National TB Control Programme (NTP) with DOTS strategy through a project funded by a World Bank loan. Key motives for the revised NTP-DOTS were to reduce financial barriers to patients by removing fee charges for diagnosis and treatment, and to address regressive suppliers' incentives for appropriate referrals. This study aims to assess to what extent China's NTP subsidies are achieving the objective of removing financial barriers to care in terms of patients' expenditure. One county with NTP-DOTS - Jianhu - and one county without - Funing - were selected. A cohort of 493 tuberculosis patients newly diagnosed in 2002 was interviewed by questionnaire. The main outcome measure was tuberculosis patients' expenditure on medical care and transportation/accommodation from the onset of symptoms to treatment completion. During the follow-up period, Funing started implementing NTP-DOTS, which offered a possibility of longitudinal comparison both between counties and within county. Ninety-four per cent (465/493) of subjects were followed-up. The mean total patient's expenditure on TB medical care and transportation/accommodation before TB diagnosis was higher in Jianhu than in Funing (715 vs. 256CNY), whereas it was higher in Funing (835 vs. 157CNY) after diagnosis. After implementing NTP-DOTS in Funing, expenditure after diagnosis decreased slightly whereas expenditure before diagnosis increased remarkably. We found that the market incentive structures in the reformed health system appear to have a stronger regressive effect and may result in prolonged delays before effective treatment can be given. We believe that doctors adapt to new incentive structures, with bonus income being linked to the hospitals' fee-for-service revenue, and find new ways of keeping revenue at the old levels, which reduce or eliminate the intended effect of the subsidies. TB patients suffer a heavy economic burden even in counties where NTP-DOTS treatment is subsidized. The total patient expenditure was reduced only marginally, but shifted substantially from after diagnosis to before diagnosis. The shift could imply delays in diagnosis and treatment with an increased risk of infection transmission.
机译：1992年，中国通过世界银行贷款资助的一个项目，启动了采用DOTS策略的现代国家结核病控制规划（NTP）。修订后的NTP-DOTS的主要动机是通过消除诊断和治疗的费用来减少患者的财务障碍，并解决供应商对适当转诊的激励措施。这项研究旨在评估中国的NTP补贴在多大程度上实现了消除患者医疗支出方面的财务障碍的目标。选择了一个带有NTP-DOTS的县（建湖）和一个没有NTP-DOTS的县（阜宁）。问卷调查了2002年新诊断的493名结核病患者。主要结局指标是结核病患者从症状发作到治疗完成所需的医疗保健和交通/住宿费用。在后续期间，Funing开始实施NTP-DOTS，这提供了县与县之间纵向比较的可能性。随访了94％（465/493）的受试者。建湖县结核病诊断前患者在结核病医疗和运输/住宿上的平均总支出高于阜宁市（715 vs. 256CNY），而阜宁市诊断后结核病的平均支出更高（835 vs. 157CNY）。在阜宁实施NTP-DOTS后，诊断后的支出略有下降，而诊断前的支出却显着增加。我们发现，在改革后的医疗体系中，市场激励结构似乎具有更强的回归作用，并可能导致长时间的延误才能给予有效治疗。我们认为，医生会适应新的激励机制，将奖金收入与医院的有偿服务收入挂钩，并找到保持收入不变的新方法，从而减少或消除补贴的预期效果。即使在有NTP-DOTS治疗补贴的县，结核病患者也承受着沉重的经济负担。患者总支出仅略有减少，但从诊断后到诊断前发生了大幅变化。这种转变可能意味着诊断和治疗的延迟，并增加感染传播的风险。

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