Study On The Input And Use Of Special Funds On Tuberculosis Control In Seven Demonstration Districts Of Shanghai

Objective:To understand the source,amount and use of special funds on tuberculosis control in seven demonstration districts of Shanghai by carrying out qualitative and quantitative researches on TB control institutions in seven demonstration districts of Shanghai (District Centers for Disease Control, TB designated hospitals, Community Health Service Centers).And to know the financial input of all-level TB control institutions, ways to limit fees and expenses within TB control institutions and current problems.Methods:Review literature to understand the status of input on TB prevention and control and the use of special funds.Expert meetings and individual counseling to refine the research programs, data collection tools; determining the analytical framework and the paper framework.Quantitative researches on TB control institutions,including 7 CDC,17 TB designated hospitals,100 community health service centers and 728 TB patients to understand the financial status and ways of TB expenditure control at all-level institutions, work-related indicators, sources and use of special funds on TB control and treatment costs of TB patients.Qualitative researches on leaders in all-level TB control institutions, medical personnel and patients.Results:1. Total specific funds from the government (central, municipal and district-level) in seven demonstration districts increased from 3.88 million in 2006 to 6.77 million in 2009, with an increase rate of 75%.And the increase rate was up to 400% in some districts during the five years. District-level input accounted for the largest share of special funds. Special funds per capita in seven demonstration districts is more than the national standard.2. From 2006 to 2009,Gini coefficient on population declined after a brief rally; Gini coefficient on epidemic fell to 0.35 in 2009; Gini coefficient on geography peaked in 2008 after a slight decline.3. Five out of seven demonstration districts participated in the fifth round of the Global Fund and there exists disbursement delays of Global Fund.4. Several demonstration districts increased subsidies for incentives of reported cases compared with the national standard which is 10 yuan/case.5. From 2005 to 2009, the amount of treatment reduction on patients in seven demonstration districts increased and it increased from 1.006 million in 2005 to 2.828 million in 2009.6. Supervision fees of patients in seven demonstration districts are more than the national standard. And the districts which participated in Global Fund have implemented the same standards of supervision fees for the floating population as other Global Fund areas.7. Most TB designated institutions in Shanghai are set in the general hospital, working as a department of the hospital. The hospitals can get financial support from municipal and district-level government. The amount related to district economic and social situation.Parts of the TB designated institutions will get varying degrees of special subsidies from district. However, cost is much larger than subsidies.8. Local patients spend more money than the floating patients on treatment. While the self-payment proportion of local patients (42.9%) is lower than that of floating patients (56.0%).Re-treated patients pay more money than newly diagnosed patients.Conclusions:1. Government in Shanghai pays much attention to TB prevention and control. The funding input is guaranteed.2. Global Fund opens a new way to get financial support. The requirement of project management enhanced the personnel's operational and financial management capability.3. There exists a big gap in the geographical and population fairness in the seven demonstration districts of Shanghai. And the gap in the epidemic fairness decreased from 2006 to 2009. Epidemic, population, geographical conditions and other factors need to be considered when investing in TB control.4. The subsidy for TB designated institutions is relatively insufficient. And it is the institutions to bear most cost.5. Percentage of public health subsidies to general hospitals need to be clarified. And the percentage public health funding to TB control need to be clarified as well.6. The amount of treatment reduction on patients is more in Shanghai than other parts of the country. But there still exists high medical costs and unreasonable expenses. There still exists high proportion of use of second-line drugs at all-level of TB designated institutions.7. Subsidies for incentives of reported cases still need to be increased. The distribution frequency and ways need to be improved.Reccomodations:1. Improve the incentive mechanism and increase the subsidy for reported cases and patient supervision. The distribution frequency and ways need to be paid more attention to.2. Raise the compensation standard for TB designated institutions and increase the amount of subsidy.3. Clarify the ratio of public health funds and the disbursement of TB funds.Improve the mechanism of performance appraisal.4. Expand the scope of treatment reduction to further reduce the burden on patients.5. Integrate multiple resources and make full use of public health funding. To have the tuberculosis work involved in the community daily work.