User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation.
User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation.
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DOI：
10.1186/1472-6963-12-412
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发表时间：
2012-11-21
影响因子：
2.8
通讯作者：
Queuille L
中科院分区：
文献类型：
--
作者：
Ben Ameur A;Ridde V;Bado AR;Ingabire MG;Queuille L
2006年，布基纳法索议会通过了一项政策，旨在降低该国保健中心产科服务和新生儿护理的直接费用，以降低该国较高的全国孕产妇死亡率和发病率。实施是通过覆盖80%成本的“部分豁免”。2008年，德国非政府组织HELP在两个卫生区启动了一项试点项目，以免除剩余20%的用户费用。无论是否有任何豁免，在布基纳法索保健中心分娩的妇女都面临额外的费用，这往往是获得保健服务的另一个障碍。我们比较了在提供部分豁免和完全豁免的保健中心分娩的总成本，以评估对额外自付费用的影响。采用病例对照研究比较医疗费用。病例对象是在多里和塞巴地区的12个保健中心分娩的妇女，在这些保健中心，HELP免除了产科服务和新生儿护理的全部费用。控制工作由邻近吉博区的六个保健中心进行，那里实行部分收费豁免。在总共870名妇女中，每个保健中心随机抽取约50名妇女。在完全免除产科服务和新生儿护理方面存在执行差距。来自Sebba的样本中只有1.1%的人在分娩相关费用上支出过多，而来自Dori的样本中有17.5%的人在分娩相关费用上支出过多，这表明在Sebba分娩的妇女比来自Dori的妇女面临过多医疗费用的风险要小得多。完全豁免保健区的额外自付费用考虑到家庭的支付能力，较贫穷的妇女通常支付较少。我们发现，取消在医院分娩的费用对最贫困的家庭尤其有利。与分娩直接费用相关的过度支出令人担忧，因此政府迫切需要取消产科和新生儿护理的所有直接费用。但是，完全取消用户收费的政策是不够的；执行过程必须有一个彻底的监测系统，以减少执行差距。
In 2006, the Parliament of Burkina Faso passed a policy to reduce the direct costs of obstetric services and neonatal care in the country’s health centres, aiming to lower the country’s high national maternal mortality and morbidity rates. Implementation was via a “partial exemption” covering 80% of the costs. In 2008 the German NGO HELP launched a pilot project in two health districts to eliminate the remaining 20% of user fees. Regardless of any exemptions, women giving birth in Burkina Faso’s health centres face additional expenses that often represent an additional barrier to accessing health services. We compared the total cost of giving birth in health centres offering partial exemption versus those with full exemption to assess the impact on additional out-of-pocket fees. A case–control study was performed to compare medical expenses. Case subjects were women who gave birth in 12 health centres located in the Dori and Sebba districts, where HELP provided full fee exemption for obstetric services and neonatal care. Controls were from six health centres in the neighbouring Djibo district where a partial fee exemption was in place. A random sample of approximately 50 women per health centre was selected for a total of 870 women. There was an implementation gap regarding the full exemption for obstetric services and neonatal care. Only 1.1% of the sample from Sebba but 17.5% of the group from Dori had excessive spending on birth related costs, indicating that women who delivered in Sebba were much less exposed to excessive medical expenses than women from Dori. Additional out-of-pocket fees in the full exemption health districts took into account household ability to pay, with poorer women generally paying less. We found that the elimination of fees for facility-based births benefits especially the poorest households. The existence of excessive spending related to direct costs of giving birth is of concern, making it urgent for the government to remove all direct fees for obstetric and neonatal care. However, the policy of completely abolishing user fees is insufficient; the implementation process must have a thorough monitoring system to reduce implementation gaps.
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影响因子：
3.5
作者：
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通讯作者：
Pritchett, LH
影响因子：
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作者：
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