Evaluating the policy of setting up microscopy centres at township hospitals in Shandong China: Experience from patients and providers
Background Since 2004 the China Ministry of Health policy has required microscopy centres (MCs) to be set up in one third of township hospitals nationally, to improve the accessibility of sputum smear testing for TB in rural areas. The objective of this study was to assess the performance of MCs in Shandong province from both patient and provider perspectives.Methods A survey of 245 TB suspects was conducted in 8 counties of Shandong stratified by MC performance. Seventy-two health providers and administrators were interviewed at the township and county levels.Results General performance of MC was poor. In 2006, the high and low performance groups checked on average 190 and 24 TB suspects, respectively. The majority of TB suspects who visited a MC did not have their sputum checked, or sputum was checked but the result was not recorded. TB suspects who visited a MC tended to live closer to it and had better knowledge of the MC than those who visited the county TB dispensary (CTD) directly. Patients with severe TB symptoms tended to go directly to the CTD. No significant difference in medical expenses before the TB diagnosis or diagnostic delay was found between TB suspects who visited a MC and those who did not. Several reasons were identified. The policy tried to set up too many MCs regardless of transportation conditions. It lacked operational details. Township hospitals had limited funding, qualified staff, and technical support from the CTD. The existing referral incentive discouraged sputum checks at the MC.Conclusion The national MC policy fell short of its goals in Shandong. Neither patients nor providers were interested in using MC in its current form. Policy recommendations are given.
If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Bloom, Gerald & Xingyuan, Gu, 1997. "Health sector reform: Lessons from China," Social Science & Medicine, Elsevier, vol. 45(3), pages 351-360, August.
- Zhang, Tuohong & Liu, Xiaoyun & Bromley, Helen & Tang, Shenglan, 2007. "Perceptions of tuberculosis and health seeking behaviour in rural Inner Mongolia, China," Health Policy, Elsevier, vol. 81(2-3), pages 155-165, May.
- Wei, Xiaolin & Walley, John & Zhao, Jin & Yao, Hongyan & Liu, Jianjun & Newell, James, 2009. "Why financial incentives did not reach the poor tuberculosis patients? A qualitative study of a Fidelis funded project in Shanxi, China," Health Policy, Elsevier, vol. 90(2-3), pages 206-213, May.
When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:95:y:2010:i:2-3:p:113-121. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Zhang, Lei)or () The email address of this maintainer does not seem to be valid anymore. Please ask to update the entry or send us the correct address
If references are entirely missing, you can add them using this form.