An Evaluation of Healthcare Use and Child Morbidity 4 Years After User Fee Removal in Rural Burkina Faso
An Evaluation of Healthcare Use and Child Morbidity 4 Years After User Fee Removal in Rural Burkina Faso
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布基纳法索农村取消使用费四年后的医疗保健使用和儿童发病率评估
DOI：
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发表时间：
2018
影响因子：
2.3
通讯作者：
K. Zinszer
中科院分区：
文献类型：
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作者：
David Zombré;M. De Allegri;R. Platt;V. Ridde;K. Zinszer
目的增加获得医疗保健的经济机会被认为是改善儿童健康结果的关键，但现有的证据增加获得和健康之间的关系仍然很少。推出四年后，我们评估了用户费用取消干预对5岁以下儿童疾病发生概率和使用卫生服务可能性的背景影响。我们还探讨了对医疗保健获得不平等的潜在影响。方法我们采用比较横断面设计，根据干预开始后几年在一个干预区和一个比较区收集的家庭调查数据。倾向评分加权用于实现两个地区之间的协变量的平衡，然后通过logistic多层次模型估计平均边际效应（AME）。结果我们估计，干预区与非干预区相比，在降低疾病发生概率方面没有显著差异[AME 4.4; 95%CI 1.0-9.8]。然而，生活在干预区的儿童使用卫生服务的概率比对照区高17.2%（95%CI 15.0-26.6），对于严重疾病事件，对照区的儿童使用卫生服务的概率上升到20.7%（95%CI 9.9-31.5）。不同社会经济地位的人使用卫生服务的概率无显著差异[χ2（5）= 12.90，p = 0.61]。实践结论在我们的研究中，我们发现，从长远来看，取消用户费用导致卫生服务使用的显着增加，但它本身并不足以降低疾病发生的风险和卫生服务使用中的社会经济不公平。
Objectives Increasing financial access to healthcare is proposed to being essential for improving child health outcomes, but the available evidence on the relationship between increased access and health remains scarce. Four years after its launch, we evaluated the contextual effect of user fee removal intervention on the probability of an illness occurring and the likelihood of using health services among children under 5. We also explored the potential effect on the inequality in healthcare access. Methods We used a comparative cross-sectional design based upon household survey data collected years after the intervention onset in one intervention and one comparison district. Propensity scores weighting was used to achieve balance on covariates between the two districts, which was followed by logistic multilevel modelling to estimate average marginal effects (AME). Results We estimated that there was not a significant difference in the reduced probability of an illness occurring in the intervention district compared to the non-intervention district [AME 4.4; 95% CI 1.0–9.8)]. However, the probability of using health services was 17.2% (95% CI 15.0–26.6) higher among children living in the intervention district relative to the comparison district, which rose to 20.7% (95% CI 9.9–31.5) for severe illness episodes. We detected no significant differences in the probability of health services use according to socio-economic status [χ2 (5) = 12.90, p = 0.61]. Conclusions for Practice In our study, we found that user fee removal led to a significant increase in the use of health services in the longer term, but it is not adequate by itself to reduce the risk of illness occurrence and socioeconomic inequities in the use of health services.
影响因子：
7.7
作者：
Muller, Clemma J.;MacLehose, Richard F.
通讯作者：
MacLehose, Richard F.