Evaluating the effects of providing financial incentives to tuberculosis patients and health providers in China.
SETTING: A project was implemented in 50 low-income counties of Shanxi, China, where transport incentives were provided to poor patients for their first visit for tuberculosis (TB) diagnosis as well as for referral, and supervision incentives were provided for doctors. OBJECTIVE: To evaluate the effects of providing incentives on TB case detection and treatment. METHODS: A group of 51 control counties in Shanxi comparable to the intervention counties was selected. Routine TB reporting was reviewed at baseline (January-September 2004) and during the project period (January-September 2005) in both groups. A patient survey was conducted in two counties in each group, with interviews of 119 new smear-positive patients treated during the intervention. RESULTS: Patients who received travel incentives had an annual individual income similar to those who did not. The notification rates of new smear-positive cases improved in both groups; however, improvement was less marked in the intervention group (70%) than in the control group (99%). Travel incentives did not reduce patient and doctor delays in the intervention group compared with the control group (P > 0.05). CONCLUSION: Providing incentives was not effective in improving TB control. There are two possible reasons for this: the poor were not well-targeted due to a lack of operational tools, and more influential health systems issues were not addressed. [Summaries available in French and Spanish].
The International Journal of Tuberculosis and Lung Disease (2008) Volume 12, Number 10, pp. 1166-1172.