Is XXXX Treatment Really Free in China? A Study Comparing Two Areas with Different Management Models.

@entity1 @entity378
OBJECTIVE: China has implemented a free-service policy for @entity378 . However, @entity1 still have to pay a substantial proportion of their annual income for treatment of this disease. This study describes the economic burden on @entity1 with @entity378 ; identifies related factors by comparing two areas with different management models; and provides policy recommendation for @entity378 control reform in China. METHODS: There are three @entity378 management models in China: the @entity378 dispensary model, specialist model and integrated model. We selected Zhangjiagang (ZJG) and Taixing (TX) as the study sites, which correspond to areas implementing the integrated model and dispensary model, respectively. @entity1 diagnosed and treated for @entity378 since January 2010 were recruited as study subjects. A total of 590 @entity1 (316 @entity1 from ZJG and 274 @entity1 from TX) were interviewed with a response rate of 81%. The economic burden attributed to @entity378 , including direct costs and indirect costs, was estimated and compared between the two study sites. The Mann-Whitney U Test was used to compare the cost differences between the two groups. Potential factors related to the total out-of-pocket costs were analyzed based on a step-by-step multivariate linear regression model after the logarithmic transformation of the costs. RESULTS: The average (median, interquartile range) total cost was 18793.33 (9965, 3200-24400) CNY for @entity1 in ZJG, which was significantly higher than for @entity1 in TX (mean: 6598.33, median: 2263, interquartile range: 983-6688) (Z = 10.42, P < 0.001). After excluding expenses covered by health insurance, the average out-of-pocket costs were 14304.4 CNY in ZJG and 5639.2 CNY in TX. Based on the multivariable linear regression analysis, factors related to the total out-of-pocket costs were study site, age, number of clinical visits, residence, diagnosis delay, hospitalization, intake of liver protective drugs and use of the second-line drugs. CONCLUSION: Under the current "free of diagnosis and treatment" policy, the financial burden remains heavy on @entity378 @entity1 . Policy makers need to consider appropriate steps to lessen the burden of out-of-pocket costs for @entity378 @entity1 in China and how best to improve service delivery for poor @entity1 .
