Study On Effect And Its Influencing Factors Of Incentive Mechanism In Tuberculosis Control

Background :In the recent decade, incentive mechanisms have been introduced in tuberculosis control globally. However, they had not been evaluated sufficiently. There were many reasons for that, for instance different contents and contexts, complexity of implementing. Thus the results of the effect evaluation are quite distinct. Also difficulties had been encountered on how to interpret the results appropriately. And we did not find much domestic literature on this issue, whereas studies of the issue has been urgently needed.Objectives :To evaluate the effect of incentive mechanism in TB control, and to explore influencing factors of the effect of incentive mechanism.Methods :â‘ Regular surveillance data were collected. New smear positive TB notification rate and cure rate of the case and the control counties in first 3 quarters of 2004 and 2005 in Shanxi province were compared.â‘¡A questionnaire survey was conducted in intervention and control counties interviewing a total of 119 TB patients treated during the project period.â‘¢Semi-structured interview were conducted to gathering information about stakeholders' attitude, implementation process etc. All of the interviews were analyzed by theme framework method.Results :â‘ NSP notification rate of intervention and control counties improved significantly. Due to significance were detected before and after the implementing of intervention between two groups, we are still unable to attribute the difference to the implementation of intervention. Cure rate of intervention group maintained on a high level, in the contrary, that of control group improved a lot.â‘¡Patient delay and doctor delay, which are the target effect of the intervention have no significance. Also the number before diagnosis between two groups have no significance.â‘¢Average medical cost after diagnosis of patients from intervention group were lower than that of control group.â‘£Many factors could influence the effect of incentive mechanism, involving the designing and implementation of incentive mechanism, local social and geographic context, the status of patient himself, and the attitudes of stakeholders.Conclusions :â‘ Although TB control improved a lot during 2004 and 2005 in Shanxi province, we still cannot attribute the progress to the implementing of incentive mechanism.â‘¡The implementation of incentive mechanism regulated the diagnosis and treatment of TB dispensary. it also enhanced TB health education. It facilitated the continuable development of TB control.â‘¢Many factors can influence the effect of incentive mechanism, for example social circumstance, geographic context, TB policy and program and personal characteristic etc. Therefore we must considering these factors comprehensively when we conduct the evaluation of incentive mechanism.