Providing financial incentives to rural-to-urban tuberculosis migrants in Shanghai: an intervention study

Abstract

BackgroundFinancial issues are major barriers for rural-to-urban migrants accessing tuberculosis (TB) care in China. This paper discusses the effectiveness of providing financial incentives to migrant TB patients (with a focus on poor migrants in one district of Shanghai using treatment completion and default rates), the effect of financial incentives in terms of reducing the TB patient cost, and the incremental cost-effectiveness ratio of the intervention.ResultsNinety and ninety-three migrant TB patients were registered in the intervention and control districts respectively. TB treatment completion rates significantly improved by 11% (from 78% to 89%) in the intervention district, compared with only a 3% increase (from 73% to 76%) in the control district (P = 0.03). Default rates significantly decreased by 11% (from 22% to 11%) in the intervention district, compared with 1% (from 24% to 23%) in the control district (P = 0.03). In the intervention district, the financial subsidy (RMB 1,080/US$170) accounted for 13% of the average patient direct cost (RMB 8,416/US$1,332). Each percent increase in treatment completion costs required an additional RMB 6,550 (US$1,301) and each percent reduction in defaults costs required an additional RMB 5,240 (US$825) in the intervention district.ConclusionsOverall, financial incentives proved to be effective in improving treatment completion and reducing default rates among migrant TB patients in Shanghai. The results suggest that financial incentives can be effectively utilized as a strategy to enhance case management among migrant TB patients in large cities in China, and this strategy may be applicable to similar international settings.

Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis

“…Twelve studies presented patient or treatment supporters directed financial interventions (among then seven quasi-experimental studies), including monetary incentives 22,24,25,27,28,29,35,39,40,41 , a conditional cash transfer program 42 and economic support by voucher delivery 43 . Some studies 22,27,28,35 combined financial and non-financial interventions.…”

Outcome of a grocery voucher incentive scheme for low-income tuberculosis patients on directly observed therapy in Singapore

“…It is very likely that the increase in the treatment completion rate of the present study was not as large as that of the aforementioned study because the patients in the present study were not a select non-adherent group. Wei et al (12) found that when poor, migrant patients with TB in a Shanghai district were given financial incentives, TB treatment completion rates significantly improved by 11% (from 78% to 89%). The use of modest incentives via a structured programme has been proven to improve the effectiveness of public health interventions conducted in poor, urban populations.…”

“…However, the use of cash incentives is controversial. (12)(13)(14)(15) In Tulsky et al's study, (15) homelessness, alcoholism and drug abuse were identified as reasons for poor adherence, and cash incentives were found to be more effective than non-cash incentives in improving treatment adherence in these patients. Nevertheless, like Bock et al, (7) we opted to use non-cash grocery vouchers instead of cash incentives.…”

“…(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) As TB disproportionately afflicts the poor, financial and social factors may affect adherence to treatment. An incentive scheme called 'DOT & Shop', which is sponsored by SATA CommHealth, a local non-governmental organisation, was implemented in July 2009 for low-income TB patients treated at Singapore's TB Control Unit (TBCU).…”

Faktor Penghalang dan Penggalak Kepatuhan daripada Perspektif Pesakit Tuberkulosis Cicir Rawatan di Kuala Lumpur

“…Kadar cicir rawatan menurun secara signifikan sebanyak 11.0% (daripada 22.0% kepada 11.0%) dalam kumpulan intervensi, berbanding dengan hanya 1.0% (daripada 24.0% kepada 23.0%) dalam kumpulan kawalan (Wei et al 2012).…”