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Open Access Research Article

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

Xiaolin Wei1, Guanyang Zou2*, Jia Yin2, John Walley3, Huaixia Yang4, Merav Kliner3 and Jian Mei5

Author Affiliations

1 School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China

2 COMDIS China Program, Nuffield Centre for International Health and Development, University of Leeds, Room 403, No. 1032 Dongmen North Rd, Luohu District, Shenzhen, 518003, China

3 Nuffield Center for International Health and Development, University of Leeds, 101 Clarendon Rd, Leeds, LS2 9LJ, UK

4 Shanghai Changning District Center for Disease Control and Prevention, No.39 Yun Wu Shan Rd, Shanghai, China

5 Shanghai Center for Disease Control and Prevention, No. 1380 Zhongshan Xi Rd, Shanghai, China

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Infectious Diseases of Poverty 2012, 1:9  doi:10.1186/2049-9957-1-9

Published: 1 November 2012

Abstract

Background

Financial 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.

Results

Ninety 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.

Conclusions

Overall, 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.

Keywords:
Public health; Tuberculosis; Domestic migrants; Poverty; Financial incentive; Treatment completion; Effectiveness