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APHA Scientific Session and Event Listing

Jingbo Yu, MHA, Health Service Research, Management and Policy, University of Florida, PO Box 100227, Florida Center for Medicaid and Uninsured, University of Florida, Gainesville, FL 32610, 352-273-5245, jyu@phhp.ufl.edu

Background: Since the 1990s, health policy in China has encouraged the privatization of rural health clinics. . Village clinics are the major source of primary care in rural China. Before economic reform, village clinics cooperated closely with upper-level public health institutions in tuberculosis (TB) control. The performance of village clinics in TB control after privatization was unclear.

Objective: The objective of this study is to describe the role of private village clinics in TB control (including share of first contacts, referral behaviors, and treatment management practices), and to explore factors influencing their TB care provision.

Method: In this cross-sectional case study, investigators from Shandong University conducted face-to-face interviews with doctors from 63 village clinics and 59 TB patients in three counties. Interviews were conducted in 2003. Other data sources include files of County Tuberculosis Dispensary (CTBD), and 3 focus groups among staff of each CTBD.

Results: 71.2 percent of rural TB patients first went to village clinics with TB symptoms. Patient delay was shorter among TB patients who initiated care in village clinics than those who first visited other institutions. Most village doctors diagnosed cold or pneumonia and gave anti-symptom and/or antibacterial treatment to suspected tuberculosis patients (STBPs) at first visit; if the symptoms weren't relieved or became aggravated in a couple of days they would refer patients to a hospital or CTBD. Among clinics visited by STBPs, 46.5% referred STBPs to CTBDs as suggested by the TB Control Guidelines. During treatment 45.8 percent of the patients were supervised by village clinics to receive medication dosage as suggested by Guidelines. Both referral-to-CTBD rate and management practice rate were higher in Z county, where referral reward (20 yuan/TB case) and management fee (60 yuan/patient) from CTBD were guaranteed to village clinics.

Conclusions and Policy Implication: Private village clinics are playing an important role in referring STBPs and supervising treatment of TB patients. Economic incentives from CTBD improve the performance of private village clinics in TB control. The lesson for other countries is that a public-private partnership is feasible and effective in controlling TB.

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