Patients may share cost of AIDS therapy

China is considering having patients pay part of the cost for AIDS treatment, a service the government has offered free since 2003, an official said.

Under the planned co-payment model, the government will continue to offer free, basic treatment, especially for those with financial problems, but patients can choose to pay for better medicines and therapies.

The move is designed to solve a shortage of government funding amid a rise of HIV/AIDS patients in China, Sun Xinhua, an official of the disease prevention and control bureau of the Ministry of Health, told China Daily on Thursday.

The co-payment model can also give patients access to better treatment, Sun said.

"With limited government funding, patients with the financial ability should help pay for parts of their antiretroviral therapy," he said, adding how much the patient should pay has not been decided.

Since 2003, the government promised to provide free medication only for underprivileged AIDS patients, but in reality has been offering antiretroviral therapy — a treatment needed for full-blown AIDS patients — free of charge for everybody.

A rise in the number of full-blown AIDS patients will make the practice "unsustainable", Sun said.

By the end of 2011, more than 150,000 AIDS patients were receiving antiretroviral therapy, statistics from the ministry showed.

By 2015, the number of HIV/AIDS patients in China is expected to reach 1.2 million, from 780,000 by the end of 2011, according to official estimates. That means more HIV carriers will become full-blown AIDS patients and need antiretroviral therapy in the coming years.

"Without shared responsibilities among government, society and patients, the treatment can hardly sustain itself until then," said Zhang Linqi, director of the Comprehensive AIDS Research Center at Tsinghua University.

Some patients said they are willing to pay some of their medical bills in exchange for better treatment.

The AIDS Care Center at the Dermatology and Venereology Institute in Wuhan, Hubei province, began charging AIDS patients 200 yuan ($30) a month in a pilot program since June last year.

In return, those patients receive better follow-up services and drug regimens, which have fewer side effects and improve adherence, according to Zhao Min, the chief physician at the center.

The center now has 79 patients on antiretroviral therapy, she told China Daily on Friday.

A 33-year-old patient, who preferred to be called Xiao Zhou, told China Daily: "Of course, I highly welcome better drugs that are free of charge, but given the reality and limited government funding, I accept paying part of the costs."

A college teacher in Wuhan started to receive treatment at the center in October. He did not visit the local center for disease control and prevention, where treatment is free, and said the enhanced drug regimens and services at the AIDS Care Center are the biggest attractions to him.

But some AIDS patients said the government should continue offering free antiretroviral therapy with improved regimens for all in need.

Sun, however, said that might be beyond the government's ability as medicines are costly.

For example, Tenofovir Disoproxil Fumarate, a kind of antiretroviral drug that is recommended by the World Health Organization, costs 1,400 yuan for treating a patient every month.

Wu Zunyou, director of the National Center for AIDS/STD Control and Prevention, said co-payment will help improve the treatment for AIDS patients and is in line with international practice.

Guy Taylor, program associate for advocacy and information management of UNAIDS' China office, told China Daily in an earlier interview that private healthcare systems exist worldwide, allowing people to pay extra to receive higher-quality services.

"It is possible that a co-payment model could prove effective in some contexts," he said. "It is important to explore a range of approaches to AIDS treatment provision, to evaluate which will work best in any particular national context."

As for how to implement the co-payment mechanism, Zhang said a possible approach is to include antiretroviral therapy in regular public health insurance programs. Under the programs, costs for antiretroviral therapy will be automatically shared by governments and patients.

But he also said it might take time for AIDS patients to accept the co-payment, as they have become used to free therapy for years.

At the moment, antiretroviral therapy for AIDS patients is provided by China CDC and its local branches, but Sun said hospitals should be able to do that in the future.

Official statistics showed more than half of the AIDS patients in the country were detected at hospitals.

Of the more than 80 million HIV tests conducted last year, more than 60 percent were at hospitals, mainly before surgeries or baby deliveries.

"Providing antiretroviral therapy at hospitals will help better track the patients, initiate timely treatment and avert further infections," Sun said.

Contact the writer at shanjuan@chinadaily.com.cn