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Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial
Health Policy Plan ; 22(3): 156-166, May 2007. ilus, tab
Artigo em Inglês | CidSaúde - Cidades saudáveis | ID: cid-56810
Biblioteca responsável: BR67.1
Localização: BR67.1
ABSTRACT
This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the franchise were identified. They were interviewed about social conditions, health seeking and health care costs at the time of starting treatment and again after 6 months follow-up. Routine data were used to ascertain clinical outcomes as well as to monitor trends in case notification. The franchisees contributed 2097 (21 percent) of the total 9951 total new sputum smear-positive pulmonary cases notified to the national TB programme in the study townships. The treatment success rate for new smear-positive cases was 84 percent, close to the World Health Organization target of 85 percent and similar to the treatment success of 81 percent in the national TB programme in Myanmar. People from the lower socio-economic groups represented 68 percent of the TB patients who access care in the franchise. Financial burden related to direct and indirect health care costs for tuberculosis was high, especially among the poor. Patients belonging to lower socio-economic groups incurred on average costs equivalent to 68 percent of annual per capita household income, with a median of 28 percent. However, 83 percent of all costs were incurred before starting treatment in the franchise, while 'shopping' for care. During treatment in the franchise, the cost of care was relatively low, corresponding to a median proportion of annual per capita income of 3 percent for people from lower socio-economic groups. This study shows that highly subsidized TB care delivered through a social franchise scheme in the private sector in Myanmar helped reach the poor with quality services, while partly protecting them from high health care expenditure. Extended outreach to others parts of the private sector may reduce diagnostic delay and patient costs further. (AU)
Assuntos
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Coleções: Bases de dados temática Contexto em Saúde: 11_ODS3_cobertura_universal / Agenda de Saúde Sustentável para as Américas / ODS3 - Saúde e Bem-Estar / Doenças Negligenciadas Tema em saúde: 11_delivery_arrangements / 11_financial_arrangements / 11_governance_arrangements / 11_multisectoral_coordination / Objetivo 4: Financiamento para a saúde / Meta 3.8 Atingir a cobertura universal de saúde / Meta 3.3: Acabar com as doenças tropicais negligenciadas e combater as doenças transmissíveis / Doenças Negligenciadas / Tuberculose Base de dados: CidSaúde - Cidades saudáveis Assunto principal: Médicos de Família / Tuberculose / Setor Privado / Acesso aos Serviços de Saúde Tipo de estudo: Avaliação econômica em saúde Idioma: Inglês Revista: Health Policy Plan Ano de publicação: 2007 Tipo de documento: Artigo
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Coleções: Bases de dados temática Contexto em Saúde: 11_ODS3_cobertura_universal / Agenda de Saúde Sustentável para as Américas / ODS3 - Saúde e Bem-Estar / Doenças Negligenciadas Tema em saúde: 11_delivery_arrangements / 11_financial_arrangements / 11_governance_arrangements / 11_multisectoral_coordination / Objetivo 4: Financiamento para a saúde / Meta 3.8 Atingir a cobertura universal de saúde / Meta 3.3: Acabar com as doenças tropicais negligenciadas e combater as doenças transmissíveis / Doenças Negligenciadas / Tuberculose Base de dados: CidSaúde - Cidades saudáveis Assunto principal: Médicos de Família / Tuberculose / Setor Privado / Acesso aos Serviços de Saúde Tipo de estudo: Avaliação econômica em saúde Idioma: Inglês Revista: Health Policy Plan Ano de publicação: 2007 Tipo de documento: Artigo
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