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Background Active case finding (ACF) is a potentially promising approach for the early identification and treatment of tuberculosis patients. However, evidence on its cost-effectiveness, particularly in low- and middle-income countries, remains limited. This study evaluates the cost-effectiveness of a community-based ACF practice in Shenzhen, China. Methods We employed a Markov model-based decision analytic method to assess the costs and effectiveness of 3 tuberculosis detection strategies: passive case finding (PCF), basic ACF, and advanced ACF. The analysis was conducted from a societal perspective on a dynamic cohort over a 20-year horizon, focusing on active tuberculosis (ATB) prevalence and the incremental cost-effectiveness ratio (ICER). Results Compared to the PCF strategy, the basic and advanced ACF strategies effectively reduced ATB cases by 6.8 and 10.2 per 100 000 population, respectively, by the final year of this 20-year period. The ICER for the basic and advanced ACF strategies were ¥14 757 and ¥8217 per quality-adjusted life-year, respectively. Both values fell below the cost-effectiveness threshold. Conclusions Our findings indicate that the community-based ACF screening strategy, which targets individuals exhibiting tuberculosis symptoms, is cost-effective. This underscores the potential benefits of adopting similar community-based ACF strategies for symptomatic populations in tuberculosis-endemic areas. [ABSTRACT FROM AUTHOR]

Objectives Existing evidence from high-income countries suggests that policies aimed at enhancing access to formal care can reduce the burden on informal carers and facilitate their reentry into the labor market. However, there is limited evidence regarding the specific carers who have been most affected by such insurance. This study focuses on China's long-term care insurance (LTCI) and examines its effects on informal care burden and the labor market participation of different types of informal carers. Methods Drawing data from the China Health and Retirement Longitudinal Study of 2011, 2013, 2015, and 2018, we employ a staggered difference-in-differences (DID) model with propensity score matching to analyze the impact of LTCI. To explore time-varying DID estimates, we adopted the DID event study design. Results Our study demonstrates that LTCI substantially alleviates the burden on informal carers while markedly boosting labor market participation. Notably, we found a more pronounced decrease in care burden among spouses, amounting to a reduction of 8.5 hr per month. Concurrently, LTCI's impact on enhancing labor market participation was more significant among younger household members, reflected in an average income increase of 4,534 yuan per year. Furthermore, subgroup analysis highlights that LTCI primarily benefits informal carers providing care for older people with low income or those who were farmers or previously engaged in informal sectors. Discussion Our study demonstrates that LTCI has led to a reduction in care burdens and an enhancement in labor market participation. The impact is especially pronounced for informal carers of older people with low income or those with backgrounds in farming or informal work sectors. [ABSTRACT FROM AUTHOR]

Background: In recent years, the Chinese government has been trying to improve informal-sector workers' and farmers' access to healthcare and reduce their financial burdens by introducing a plan of cost-sharing reduction, but the effect on outpatient care utilization remains unknown. Furthermore, scarce evidence has been provided to help understand the impact of cost-sharing reduction on healthcare use in low- and middle-income countries. The policy change of the coinsurance reduction for outpatient care from 75 to 55% for the enrollees of the Urban and Rural Residents Basic Medical Insurance in Taizhou, China in 2015 provides us a good quasi-experimental setting to explore such an impact.Methods: We do a quasi-experimental study to explore the impact of coinsurance reduction on outpatient care use among the informal-sector workers and farmers aged 45 and above by estimating a fixed-effects negative binomial model with the difference-in-differences approach and the matching method. Heterogeneous effects in primary care clinics and for the older people aged 60 and above are also examined. Our data is from the China Health and Retirement Longitudinal Study 2013 and 2015.Results: We find neither statistically significant impact of coinsurance reduction on outpatient care utilization in all health facilities for informal-sector workers and farmers aged 45 and above, nor heterogeneous effects in primary care clinics and for older people aged 60 and above.Conclusions: We conclude that the coinsurance reduction cannot effectively improve the informal-sector workers' and farmers' utilization of healthcare if the cost-sharing undertaken by patients remains high even after the reduction. Besides, improving healthcare quality in primary care clinics may play a more important role than merely introducing a cost-sharing reduction plan in enhancing the role of primary care clinics as gatekeepers. We propose that only a substantial coinsurance reduction may help influence the utilization of healthcare for informal-sector workers and farmers, and enhancing the healthcare quality in primary care clinics should be given priority in low- and middle-income countries. [ABSTRACT FROM AUTHOR]