Travel Subsidy Helps People With TB in China Get to Treatment

Daniel M. Keller, PhD

July 11, 2012

July 11, 2012 (Bangkok, Thailand) — For poor patients with tuberculosis (TB) in China, a transportation subsidy is an important aspect of TB treatments.

Qi Zhao, MPH, from the Department of Epidemiology at the School of Public Health, Fudan University, in Shanghai, China, told delegates here at the 15th International Congress on Infectious Diseases that a transport subsidy program (TSP) helps poor patients with TB complete treatment.

China's TB control program recommends following all patients monthly for 6 to 8 months during treatment. Because TB is related to poverty, a TSP was implemented in 12 less-developed provinces to subsidize the travel of poor TB patients to a dispensary.

If a patient can get to the dispensary, all diagnostic tests and treatment are free. However, in some counties, there is only 1 dispensary, meaning that some patients have to travel quite a distance, Zhao explained.

In 2008, the TSP was implemented with support from the World Bank Department for International Development. Dispensaries are in charge of the subsidy payments, and doctors give them to the patients directly.

In 4 participating counties, researchers evaluated its effectiveness of the TSP with patient interviews at the time of diagnosis and during follow-up. They surveyed 429 patients, 139 of whom received a subsidy. "The average transport fee for the round trip was about 16 Chinese yuan [$2.51], and we know they only received 10 yuan [$1.57] for each visit," Zhao reported. Total transport costs over the duration of therapy ranged from 0 to 700 yuan ($109.85), depending on the distance between a patient's home and the nearest dispensary; the average was 97 yuan ($15.22).

For 51% of the patients, travel costs were higher than the subsidy; this was also true for most of the patients in remote and mountainous areas. For patients in urban areas, the subsidy covered the travel costs for more than 80% of patients. Subsidized and unsubsidized patients spent about the same amount for travel, but the income of the unsubsidized patients was about 50% greater (4000 vs 6000 yuan; P < .05).

Almost all the patients said the subsidy helped them complete their treatment; only about 11% said they were not satisfied with the amount. More than 80% reported that they thought an appropriate subsidy would help patients to complete treatment.

Zhao noted that although the subsidy is adequate for most people living in urban areas with convenient access to transportation, it is insufficient to cover the travel costs for patients living in remote areas.

She said the effectiveness of the program was limited by the level of funding, the coverage area, uncertain sustainability, and the lack of an effective method to identify poor patients. She recommended enlarging the subsidy coverage area and making the subsidy amount "more elastic, especially for the mountain areas."

Session moderator Narin Hiransuthikul, MD, MPH, PhD, chair of the Department of Social and Preventive Medicine at Chulalongkorn University in Bangkok, Thailand, who was not involved in the study, told Medscape Medical News that the aim of the TSP is laudable.

"If your patient cannot come to the drug dispensary, they will have problems taking their medicine regularly." This can lead to delayed treatment and poor compliance with the treatment, Dr. Hiransuthikul said. "I think it should be government policy...to solve this kind of problem in the large scale."

He questioned whether such a program is feasible everywhere. "It depends on the situation in each country. Government policy is a major factor," he said, and whether there is money for subsidies, particularly for poor people in rural regions.

However, the problem is not only monetary; smarter planning could help. Community volunteers could be used to deliver treatment to the poorest people near their homes, eliminating their need to travel to dispensaries, Dr. Hiransuthikul suggested.

Dr. Hiransuthikul has disclosed no relevant financial relationships.

15th International Congress on Infectious Diseases (ICID): Abstract 14.004. Presented June 14, 2012.

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