Paper short abstract:

In this presentation, I examine “the price of free,” the difference between the intended goals of China’s national tuberculosis control program and patient realities, with a focus on economic costs.

Paper long abstract:

In this presentation, I explore the unintended gaps between China's national tuberculosis control program and patient realities, with a focus on economic costs. Since the early 1990s, China has scaled-up subsidized tuberculosis control programs, and in 2005, China reached 100% national DOTS coverage, through the support of foreign stakeholders. Such efforts have led to great gains in basic tuberculosis control, towards the achievement of the 2015 Millennium Development Goals (MDGs). The success of these programs has rested in part on a "double free" approach, through which patients receive both diagnostic and treatment services at no charge. Throughout this period, China has also undergone widespread reforms, which have served to fundamentally transform the economic opportunities of everyday citizens. In this context, patient realities differ significantly from the goals of the national tuberculosis control program. Drawing on research conducted in China with patients and tuberculosis public health experts, I examine "the price of free," that is, the difference between the intended goals of national policy and the realities of implementation. In doing so, I explore the tensions created by a national social model, which seeks to equitably distribute services and reduce economic barriers, and neoliberal capitalist aspirations, which reward risk and flexibility.