{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:45:00Z","timestamp":1792788300700,"version":"4.5.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo"}],"funder":[{"name":"The Government of the Republic of Korea through the Korean Disease Control and Prevention Agency and the Government of Japan through the Ministry of Health, Labour and Welfare","id":[{"id":"https:\/\/ror.org\/019xm3p48","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trop Med Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tuberculosis (TB) remains a major public health and socioeconomic challenge in the Western Pacific Region. Despite the expansion of universal health coverage (UHC), TB-affected households continue to face financial hardship. This study aimed to assess and compare financial protection mechanisms for TB services across the continuum of care in the region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional mixed-methods study in seven TB priority countries in the Western Pacific Region: Cambodia, China, Lao People\u2019s Democratic Republic, Mongolia, Papua New Guinea, the Philippines, and Viet Nam. Data were collected between January and March 2025 through a structured online questionnaire and semi-structured interviews with 21 key informants. Findings were analysed using a standardised health financing framework covering revenue raising, pooling, purchasing, and service coverage. Secondary data from the WHO Global TB finance database were used to assess funding composition and donor dependence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Countries were mapped into three financing typologies: national health service-type systems, government-subsidised mixed systems, and insurance-based pooled systems. Total TB funding in 2023 varied widely, from US$3.7 million in the Lao People\u2019s Democratic Republic to US$1.08 billion in China. External donor dependence was high in the Lao People\u2019s Democratic Republic, Viet Nam, Cambodia, and Papua New Guinea, but minimal in China. Coverage of TB services was strongest for drug-susceptible TB treatment and weakest for radiology, hospitalisation, and services subject to social health insurance co-payments. TB preventive treatment and drug-resistant TB services were frequently sustained through donor financing. Interviews identified implementation barriers including pre-diagnostic user fees, reimbursement delays, fragmented purchasing, and incentives for unnecessary hospitalisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Expansion of UHC has not consistently translated into comprehensive financial protection for TB patients. While many TB services are nominally covered, patients remain exposed to costs through pre-diagnostic fees, co-payments, reimbursement limits, and donor-dependent service components. Strengthening financial protection requires integrating TB services into pooled domestic financing, removing avoidable cost-sharing for essential TB services, and aligning purchasing mechanisms with patient-centred TB care pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41182-026-00979-7","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T03:08:52Z","timestamp":1785985732000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Assessment of financial protection mechanisms for tuberculosis services in seven priority countries of the Western Pacific Region: a cross-sectional mixed-methods study"],"prefix":"10.1186","volume":"54","author":[{"given":"Kyung Hyun","family":"Oh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeungeun","family":"Seo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yerin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fukushi","family":"Morishita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alia Cynthia","family":"Luz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huong Thi Giang","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajendra Prasad Hubraj","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin P.","family":"Grobusch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjo","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"979_CR1","volume-title":"Global tuberculosis report 2025","author":"World Health Organization","year":"2025","unstructured":"World Health Organization. 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Participation was voluntary, informed consent was obtained from all interviewees, and no personally identifiable data were collected.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"KHO, FM, ACL, HTGT, and RPY are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of the World Health Organization.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"137"}}