Marseille 2007
| Abstract #367 - The Cost of AIDS Care in China: Are Free Antiretroviral Drugs Enough? | ||||
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Session: 19.4: Universal Access to care (Parallel) on Monday @ 14.00-16.00 in HC Chaired by Shirin Heidari, Jean-Paul Moatti Authors: Presenting Author: Dr Mit Philips - Mdecins sans Frontires, Belgium |
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| Additional Authors: Mr Luc Van leemput, Mrs Suerie Moon, | ||||
| Aim: Financial access to health care is difficult for many people in China, where there is a widespread fee-for-service system but an estimated 70% of the population has no health insurance. For those living with an impoverishing illness like HIV/AIDS, this challenge becomes even more daunting. In 2003, the government launched a policy of free antiretroviral (ARV) drugs for all rural and urban poor living with HIV/AIDS. However, other components of AIDS care, which can be prohibitively expensive, were not covered, such as baseline and monitoring lab tests and drugs to treat or prevent opportunistic infections. This paper estimates the out-of-pocket costs for treatment and care that a PLWHA in China might face over the course of one year. | ||||
| Method / Issue: Mdecins Sans Frontires (MSF) operates two clinics in China providing a free package of treatment and care for HIV/AIDS in Nanning, Guangxi Province and Xiangfan, Hubei Province. As of March 2006, the projects together had followed about 850 patients, 400 of whom were on ART. Because MSF provides services free of charge, the programs pay for many costs that would otherwise be borne by the patient, providing us with detailed data that is not otherwise publicly available. Price data come from the two project sites, based on government policies, standardized lab fee schedules, actual prices paid to local drug distributors, hospitalization bills, and internal project records. We have used the prices paid by MSF to construct hypothetical out-of-pocket non-ARV expenses that a patient would face over one year, according to the national treatment guidelines. We estimated costs for seven different patient profiles, ranging from asymptomatic (WHO Stage I) through to severe disease (WHO Stage IV). | ||||
| Results / Comments: HIV/AIDS treatment can be extremely costly, cumulative patient contributions ranging from about 125 USD to 10,225 USD per year in Nanning, and 15 USD to 5304 USD per year in Xiangfan, depending on the patient's stage of illness. For a rural resident in Nanning, this translates into 37% to 3056% of average annual income, and for an urban resident, 11% to 889%. In Xiangfan, treatment cost 3.8% to 1330% of average annual income for a rural resident, and 1.5% to 521% for a city dweller. Hospitalization dramatically increased costs, with median cost of hospitalization at 912 USD in Nanning and 264 USD in Xiangfan. Costs were much higher for WHO Stage III and IV patients, who comprise about 50% of patients (WHO stage upon first arrival at the clinics). Transport costs to the health structures added to the patients expenses. | ||||
| Discussion: This study found clear evidence that the cost of AIDS care can quickly rise beyond affordable levels, and easily qualify as 'catastrophic' health expenditures. While providing ARV drugs free of charge is an important step, the costs of other components of care are also considerable and can even exceed ARV prices. These out-of-pocket costs constitute important financial barriers, excluding patients from accessing appropriate care and a considerable financial burden on households, with risk of further impoverishment. Given the negative impact on adherence and health outcomes when patients cannot afford the treatment they need, policymakers should consider providing testing, monitoring commonly-used OI drugs and basic laboratory tests free of charge to all AIDS patients, as well as financial support for hospitalization and transport. | ||||
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