The Study On The Subsidy Strategy Of TB Care Provision In The County Designated Hospitals

BackgroundTuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis,which can invade many organs and pulmonary tuberculosis infection is the most common result.It is one of the world's top ten causes of death.With the change of TB control strategy and prevention model,the responsibilities of different institutions happen to be adjusted.The designated hospitals take up in charge of free screening,registration report,diagnosis and treatment and health education of tuberculosis patients.The designated hospital model gradually being formed and becoming one of the main TB control model in China.Tuberculosis patients need both clinical health care and public health services in the course of treatment,and most patients' treatments are happened in outpatient care.In China,the outpatient cost can be covered by health insurance only in partly districts.How to combine health insurance with government reimbursement and social assistance resources is still a hard mission.In order to ensure the smooth transition and sustainable development of TB prevention and control,it is very necessary to explore the subsidy strategy of tuberculosis service for designated hospitals.ObjectiveIn this study,we analyzed the existing subsidy strategies and systems of tuberculosis service that were planned by government.According to the current situation of subsidy policies in different regions,we classify them as different reimbursement model,and then we analyzed the change of hospital operation and quality of tuberculosis control before two years and after two to four years of the designated hospital model Implementation,and discussed the possible influencing factors,summed up the experiences,put forward the subsidy strategies of TB care provision in the county designated hospitals.MethodsShandong,Hunan and Shanxi provinces were randomly selected according to the level of economic development,geographical location,and two counties were purposefully selected according to the implementation result of the designated hospital model.Data regarding quantitative and qualitative were collected through Institutional questionnaire survey and in-depth interview for key figures.The operation status of the sample designated hospital,the change between registration and the treatment effect of TB patients before and after the new model,and the compensation policy of TB service provided by the designated hospitals will be presented in this thesis.The quantitative data was entered in Microsoft Access 2007 database,descriptive statistic data analysis was finished in SPSS20.0.Qualitative data was analyzed by Nvivo.10.ResultsMost local governments have little investment in hardware facilities such as infrastructure construction and equipment for TB services in designated hospitals,and lack of compensation for tuberculosis public health services provided by hospitals.In some counties,Cost of tuberculosis outpatient service has not yet been covered by the health insurance schemes.In the different subsidy model,the designated hospital income and income structure have no changed before and after the adjustment of the responsibility.The main income of the hospital was still depend on the provision the medical service(above 94%),the fiscal subsidy makes up a very small portion of the total income(low 5%),the income of public health service was not much,The income of TB services is very little(0.81%-5.89%)compared with the total income of the hospital,which may lead to the hospital ignore the prevention and treatment of tuberculosis.In all subsidy models despite the Comprehensive subsidy model,the wages of the doctors and nurses in tuberculosis department were 0.3-0.9 times that of others,and 50-60%of which come from performance that was paied mainly depend on the deparment' medical income.It has affected the stability and sustainability of tuberculosis staff teams.In all subsidy models,the treatment of tuberculosis can basically meet the requirements of the National Tuberculosis Program,In addition to the Staff Subsidy model,the tuberculosis Patient registration rate declined from 21.41%-78.12%among other models.The lack of subsidy for the tuberculosis patient's management and supervision may hurt the enthusiasm of the hospital.In our study and management work significantly decreased in other subsidy model.Conclusion and suggestions:At present,the investment of government was insufficient for the provision of tuberculosis services by the designated hospitals.the lack of subsidy for the TB public health services provided by the designated hospitals and the not change income structure of the hospitals were common problem faced the goverment.in this study,we find that the quality of TB prevention and treatment is not high in the relatively abundant investment and subsidy,because the missing of performance appraisal.In counties where funding is not sufficient,the quality of TB prevention and treatment was better than the comprehensive subsidy model,the doctors was paying for performance and the government or hospital give them some salaries subsidy.In the county that has no subsidy,the quality of tuberculosis treatment and management declined severely.Government should help tuberculosis covered by health insurance as soon as possible in the area where is not covered and provide subsidy for the public health service,paying for performance is one of the good choices.The assessment and supervision mechanism for tuberculosis services provided by designated hospital should be established,it should clearly determine the main responsibilities of all parties to improve the quality of tuberculosis care and management.