Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia.
Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia.
复制标题
优惠券可以送吗？
DOI：
10.2471/blt.13.129122
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发表时间：
2014
影响因子：
11.1
通讯作者：
E. van Doorslaer
中科院分区：
文献类型：
--
作者：
E. van de Poel;Gabriela Flores;P. Ir;O. O’Donnell;E. van Doorslaer
目的
评价柬埔寨公共卫生保健设施产妇保健券对产妇保健服务利用的影响。
方法
该研究涉及2010年柬埔寨人口与健康调查的数据，涵盖2005年至2010年期间的出生人数。2007年首次实施的代金券计划对孕产妇保健服务利用率的影响采用差异中的差异方法进行量化，该方法将实施代金券计划的地区的利用率变化与不实施代金券计划的地区的变化进行比较。
结果
总体而言，代金券计划使在公共卫生保健设施分娩的概率增加了10.1个百分点;在最贫穷的40%家庭的妇女中，增加了15.6个百分点。在实施计划的地区，住院分娩的增加约占五分之一。普及代用券计划比针对最贫穷妇女的计划对在公共设施分娩的可能性有更大的影响。这两种计划都增加了接受产后护理的可能性，但这种增加只对非贫困妇女有意义。普及但没有针对性的代金券计划大大增加了接受产前保健的可能性。
结论
产前检查计划增加了在保健中心的分娩，并在较小程度上改善了产前和产后护理。然而，针对较贫穷妇女的计划似乎效率不高，因为这些妇女比不太贫穷的妇女更有可能被鼓励在公共保健设施分娩，即使有普遍的代金券计划。
OBJECTIVE
To evaluate the effect of vouchers for maternity care in public health-care facilities on the utilization of maternal health-care services in Cambodia.
METHODS
The study involved data from the 2010 Cambodian Demographic and Health Survey, which covered births between 2005 and 2010. The effect of voucher schemes, first implemented in 2007, on the utilization of maternal health-care services was quantified using a difference-in-differences method that compared changes in utilization in districts with voucher schemes with changes in districts without them.
FINDINGS
Overall, voucher schemes were associated with an increase of 10.1 percentage points (pp) in the probability of delivery in a public health-care facility; among women from the poorest 40% of households, the increase was 15.6 pp. Vouchers were responsible for about one fifth of the increase observed in institutional deliveries in districts with schemes. Universal voucher schemes had a larger effect on the probability of delivery in a public facility than schemes targeting the poorest women. Both types of schemes increased the probability of receiving postnatal care, but the increase was significant only for non-poor women. Universal, but not targeted, voucher schemes significantly increased the probability of receiving antenatal care.
CONCLUSION
Voucher schemes increased deliveries in health centres and, to a lesser extent, improved antenatal and postnatal care. However, schemes that targeted poorer women did not appear to be efficient since these women were more likely than less poor women to be encouraged to give birth in a public health-care facility, even with universal voucher schemes.