Impacts of the “transport subsidy initiative on poor TB patients” in Rural China: A Patient-Cohort Based Longitudinal Study in Rural China

OBJECTIVE To describe the financial burden on TB patients for transportation during treatment, and to evaluate the impacts of the "transportation subsidy initiative on poor TB patients" in rural China for improving poor patients' access to TB treatment. METHODS A Case-cohort of 429 TB patients was investigated through questionnaire interviews in four counties of two provinces in China. Information on the financial burden for transportation during TB diagnosis and treatment was collected. Qualitative in-depth interviews with 26 TB patients were carried out to understand their perceptions of transportation subsidy initiative. RESULTS The mean transportation cost of TB medical care was 97 CNY (70 CNY in median), varying from 0 to 700 CNY. About 51% of the patients spent more than 10 CNY per round trip to the TB dispensary. Of the 429 TB patients investigated, 139 had received transportation subsidies after getting TB diagnosis; 15/139 (10.9%) showed dissatisfaction, mainly because the subsidy amount being insufficient. The income of patients receiving transportation subsidies was significantly lower than those not receiving the subsidies (p<0.05). The impression that an appropriate transportation subsidy enables patients to complete the required visits during their TB treatment was obtained after observation of over 80% of the patients. CONCLUSION The transportation subsidy plays an important role in reducing financial burden on poor TB patients for the completion of treatment. However, the coverage was limited and the amount of subsidy was not enough under the present policy. Considering the poverty of rural TB patients, a universal coverage and a rational amount of transportation subsidy should be proposed.