Objective: To measure patient expenditure on additional drugs and tests in public services where tuberculosis (TB) drugs are supplied for free.
Methods: Questionnaire survey of patients currently on treatment in eight TB dispensaries in two provinces; in depth interviews with providers at the facilities.
Results: Liver protection drugs (141/163) were prescribed for 86% of patients, 93% had one or more tests in the last month, and 23% were on treatment past the World Health Organization-recommended treatment duration. All but two patients were charged for something in cash at each visit: on average 287 Chinese Yuan (40 US dollars) in the previous month. For patients below the poverty line, drug and test expenditure was 1.85 times their average household monthly income. Average charges varied little between income categories. In terms of anti-TB drugs prescribed, 17.8% of regimens were inadequate by international standards. Providers reported they prescribe liver protection drugs to avoid medical negligence, and they believed they were effective; and the government subsidy for providing TB treatment was simply not enough.
Conclusions: Despite an ostensibly fully subsidised TB programme in China, patients are charged substantive amounts irrespective of income. Research is needed to confirm these practices are widespread but this needs to be coupled with financing strategies to tackle it.