Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India

Abstract

IntroductionThere are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents. Provider payment reform by strategic purchasing through output based payments (lump sum fee is reimbursed as per the MDR-TB benefit package rates) to the providers – both public and private health facilities empanelled under the insurance scheme was the key intervention.AimTo understand the implementation gap between policy and practice of the benefit packages with respect to equity in utilization of package claims by the poor patients in public and private sector.MethodsData from primary health insurance claims from January 2013 to December 2015, were analysed using an extension of ‘Kingdon’s multiple streams for policy implementation framework’ to explain the implementation gap between policy and practice of the MDR-TB benefit packages.ResultsThe total number of claims for MDR-TB benefit packages increased over the study period mainly from poor patients treated in public facilities, particularly for the pre-treatment evaluation and hospital stay packages. Variations and inequities in utilizing the packages were observed between poor and non-poor beneficiaries in public and private sector. Private providers participation in the new MDR-TB financial protection mechanism through the universal health insurance scheme was observed to be much lower than might be expected given their share of healthcare provision overall in India.ConclusionOur findings suggest that there may be an implementation gap due to weak coupling between the problem and the policy streams, reflecting weak coordination between state nodal agency and the state TB department. There is a pressing need to build strong institutional capacity of the public and private sector for improving service delivery to MDR-TB patients through this new health insurance mechanism.

Using an equity-based framework for evaluating publicly funded health insurance programmes as an instrument of UHC in Chhattisgarh State, India

“…Media reports suggest that this pattern has continued under PMJAY as well [110]. On the other hand, when conditions like multidrug-resistant tuberculosis were introduced under PFHI, the participation of the private sector was reported to be extremely low [111]. This reflects the practice of 'cherry picking' and the provision of narrow and selective services in the private sector documented in formal research [61,109].…”

Survival analysis of time to cure on multi-drug resistance tuberculosis patients in Amhara region, Ethiopia

“…According to WHO multidrug-resistant tuberculosis (MDR-TB) is caused by bacteria that are resistant to the most effective anti-tuberculosis drugs (isoniazid and rifampicin) [1–3]. MDR-TB results either from primary infection or develop in the course of treatment of a patient due to human error, poor supply management, poor quality anti-TB drugs and/or improper treatment [2, 4, 5]. In addition, poor infection control practice has also been identified as a major factor for the spread of MDR-TB and MDR-TB has different recovery time for different patients [6].…”

Organization of tuberculosis detection in Russia and worldwide

“…Лечение и обследование в частных клиниках оплачивается пациентами. На сегодняшний день менее 15% населения Индии имеет медицинскую страховку [9]. Все больницы и клиники сосредоточены в крупных городах, при том что сельское население фактически не имеет доступа к качественной и своевременной медицинской помощи [10].…”