Preventing the White Death: Tuberculosis Dispensaries

Egedesø, Peter; Hansen, Casper Worm; Jensen, Peter S.

doi:10.1093/ej/ueaa014

Cited by 17 publications

(15 citation statements)

References 55 publications

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“…To assess the causal effect of the Korean PPM program on TB treatment outcomes, we used the difference in differences (DID) analysis. In the field of TB, DID analysis has previously been used to evaluate long-term effects of pre-1950s TB policies/public health campaigns (limited to the United States of America and Denmark) using historical data [29][30][31]. We compared the changes in treatment outcome (TS and LTFU) between the public and private sector TB patient cohorts in 2009 and 2014.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the impact of the nationwide public–private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis

Sohn

Kim

et al. 2021

PLoS Med

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Background Public–private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea’s PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program. Methods and findings Healthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes—treatment success (TS) and loss to follow-up (LTFU)—in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and −8.7% (95% CI −9.7% to −7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program’s impact on TB mortality. Conclusions We found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.

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Section: Discussionmentioning

confidence: 99%

Evaluating the impact of the nationwide public–private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis

Sohn

Kim

et al. 2021

PLoS Med

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“…To further attenuate concerns regarding other unobserved factors affecting the treatment districts, we propose a falsification test based on placebo regressions (Athey & Imbens, 2017; Egedesø, Hansen, and Jensen 2020). In absence of pre‐ or post‐treatment data which allow directly testing for differential trends, we analyze two variables that should not show any response to the SAM program over the study period unless there were other policy initiatives or local changes affecting the health system.…”

Section: Methodsmentioning

confidence: 99%

Impact of social accountability monitoring on health facility performance: Evidence from Tanzania

2021

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Social accountability programs are increasingly used to improve the performance of public service providers in low‐income settings. Despite their growing popularity, evidence on the effectiveness of social accountability programs remains mixed. In this manuscript, we assess the impact of a social accountability intervention on health facility management exploring quasiexperimental variation in program exposure in Tanzania. We find that the social accountability intervention resulted in a 1.8 SD reduction in drug stockouts relative to the control group, but did not improve facility infrastructure maintenance. The results of this study suggest that social accountability programs may be effective in areas of health service provision that are responsive to changes in provider behavior but may not work in settings where improvements in outcomes are conditional on larger health systems features.

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“…Yet, Jacobs stresses that the census bureau is doing everything it can to correct the mortality statistics. 21 The census bureau provides a section in "Mortality Statistics" on the accuracy of the data and in 1911, for example, evidence suggests that active pulmonary TB deaths were diagnosed correctly in 60 percent of the cases. By 1920, this is no longer highlighted and the statistics provided for that year suggest that the queries made to physicians by the census bureau about pulmonary TB diagnoses only increased the total number of TB deaths by 0.2 percent with a similar number for, e.g., 1922.…”

Section: Datamentioning

confidence: 99%

“…2 Empirical work supporting that clean water and sanitation mattered includes Cutler and Miller (2005), Ferrie and Troesken (2008), Clay et al (2014), and Alsan and Goldin (forthcoming). Regarding TB, research by Hollingsworth (2014) and Egedesø et al (2017) suggests that interventions targeted at TB were, in fact, successful in the pre-antibiotic era. 3 An article in the Boston Globe from March 18, 2016 states that, according to Framingham History Center executive director Anne Murphy, the Framingham Demonstration was the first community-based participatory health study in the world.…”

Section: Introductionmentioning

confidence: 99%

Controlling tuberculosis? Evidence from the first community-wide health experiment

Clay

Egedesø

Hansen

et al. 2020

Journal of Development Economics

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This paper studies the immediate and long-run mortality effects of the first communitybased health intervention in the world, which had a particular focus on controlling tuberculosis -the so-called Framingham Health and Tuberculosis Demonstration. Comparing death and TB-mortality rates between Framingham and seven (pre-selected) control towns during the Demonstration period between 1917 and 1923, the contemporary official evaluation committee concluded that the Demonstration was highly successful in controlling TB and reducing mortality The Framingham Demonstration subsequently became a health example for the world. The findings in our paper question this very positive assessment. We collected and digitized causes-of-death data for towns/cities in Massachusetts and the United States for the period 1901-1934, allowing us to extend the number of control towns (or cities) and study whether the Demonstration reduced mortality in the long run. Compared to the official seven controls towns, we find that TB mortality in Framingham was on average lower between 1917 and 1923. In the extended control samples, these immediate TB mortality differences are smaller and often more than reversed by 1934. However, we do find robust evidence that the Demonstration reduced infant mortality, and these improvements persisted even after the Demonstration ended.

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Preventing the White Death: Tuberculosis Dispensaries

Cited by 17 publications

References 55 publications

Evaluating the impact of the nationwide public–private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis

Evaluating the impact of the nationwide public–private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis

Impact of social accountability monitoring on health facility performance: Evidence from Tanzania

Controlling tuberculosis? Evidence from the first community-wide health experiment

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