Abolition of cost-sharing is pro-poor: evidence from Uganda
Abolition of cost-sharing is pro-poor: evidence from Uganda
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DOI：
10.1093/heapol/czi012
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发表时间：
2005-03-01
影响因子：
3.2
通讯作者：
Walker, O
中科院分区：
文献类型：
--
作者：
Nabyonga, J;Desmet, M;Walker, O
目的：记录取消用户收费对乌干达卫生服务利用的影响，重点是穷人和弱势群体。方法：采用定量和定性方法对全国106家卫生机构进行纵向研究。审查了健康记录，以确定总体利用模式和弱势群体使用情况的趋势。根据乌干达贫穷参与性评估项目确定的财富排名的修改，按社会经济地位对家庭进行分类，以便比较穷人与其他社会经济群体的利用情况。调查结果：在性质波动的所有人口群体中，利用率都有显著增加。与2000年相比，公共转诊设施的使用率从2001年的26%上升到2002年的55%。低层设施的相应数字分别为44%和77%。穷人的使用率增加超过其他社会经济类别。在分摊费用之前和之后，妇女都比男子更多地利用保健服务。与五岁以下儿童相比，五岁以上儿童的使用率增加较多。预防和住院服务的使用率没有增加。在护理质素方面，二零零二年的药物缺货情况较二零零零年及二零零一年有所减少。据报告，其他指标如清洁、大院维修和工作人员可用性没有恶化。结论：该研究表明，费用分摊造成了财政障碍，减少了获得服务的机会，特别是在乌干达的穷人中。但是，需要进一步研究以澄清按年龄和性别分列的利用问题。
Objective: To document the effects of the abolition of user fees on utilization of health services in Uganda with emphasis on poor and vulnerable groups.Methods: A longitudinal study using quantitative and qualitative methods was carried out in 106 health facilities across the country. Health records were reviewed to determine trends in overall utilization patterns and use among vulnerable groups. A modification of wealth ranking as defined by the Uganda Poverty Participatory Assessment Project was used to categorize households by socio-economic status in order to compare utilization by the poor against that of other socio-economic groups.Findings: There was a marked increase in utilization in all population groups that was fluctuating in nature. The increase in utilization varied from 26% in public referral facilities in 2001, rising to 55% in 2002 compared with 2000. The corresponding figures for the lower level facilities were 44% and 77%, respectively. Increase in utilization among the poor was more than for other socio-economic categories. Women utilized health services more than men both before and after cost-sharing. Higher increases in utilization were noted among the over-five age group compared with the under-fives. There were no increases in utilization for preventive and inpatient services. With respect to quality of care, there were fewer drug stock-outs in 2002 compared with 2000 and 2001. There was no deterioration of other indicators such as cleanliness, compound maintenance and staff availability reported.Conclusion: The study suggests that there is a financial barrier created by cost-sharing that decreases access to services, especially among the poor in Uganda. However, further studies are needed to clarify issues of utilization by age and gender.