China has a TB control programme that is subsidised, but this survey found that patients are still paying substantive amounts for additional drugs and tests irrespective of their income. This includes what the study describes as ‘excessive tests’ and patients being prescribed ‘liver protection’ drugs, for which there is no research or rationale for use. For patients below the government poverty line, drug and test expenditure was 1.85 times their average household monthly income - and averaged at 40 US dollars per visit. Average charges varied little between income categories. In terms of anti-TB drugs prescribed, almost a fifth of regimens were inadequate by international standards. Providers reported they prescribe liver protection drugs to avoid claims of medical negligence, and they believed the drugs were effective; and the government subsidy for providing TB treatment was simply not enough. The authors conclude that further surveys are needed to confirm these practices are widespread but this needs to be coupled with financing strategies to tackle it.
Tropical Medicine & International Health (2010) 15 (1) 26-32 [doi: 10.1111/j.1365-3156.2009.02427.x]