The long-term effects of free care on birth outcomes: Evidence from a national policy reform in Zambia
The long-term effects of free care on birth outcomes: Evidence from a national policy reform in Zambia
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免费护理对出生结果的长期影响：来自赞比亚国家政策改革的证据
DOI：
10.1101/2021.05.18.21257410
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Lagarde M
中科院分区：
文献类型：
--
作者：
Lagarde M
由于许多国家的妇女由于经济障碍仍然无法在设施中分娩，许多人认为取消使用费是实现全民覆盖的关键一步。我们利用赞比亚自 2006 年起分阶段取消使用费的情况来估计政策变化后五年内取消使用费的影响。我们使用了两项具有全国代表性的人口统计和健康调查的出生史数据来进行双重差分分析，并确定取消用户费用对机构分娩和辅助分娩、剖腹产和新生儿死亡的因果影响。我们还探讨了政策的异质效应。取消收费在短期内影响不大，但在政策变化后两年左右就出现了较大的积极影响。在接受治疗的地区，城郊和农村地区的机构分娩分别增加了 10 个和 15 个百分点（相当于 25% 和 35% 的变化），这完全是由于家庭分娩减少所致。然而，没有证据表明改革改变了受教育程度较低的妇女的行为、剖腹产的比例或降低了新生儿死亡率。在护理质量高的地方，机构分娩量有所增加，但在护理质量低的地方，机构分娩量则没有增加。虽然取消用户收费可能会减少医疗保健支付带来的经济困难，但它不一定会改善获得护理或健康结果的公平机会。取消使用费是实现全民健康覆盖的必要步骤，但还不够，还需要同时进行改革以针对弱势群体并提高护理质量。
As women in many countries still fail to give birth in facilities due to financial barriers, many see the abolition of user fees as a key step on the path towards universal coverage. We exploited the staggered removal of user charges in Zambia from 2006 to estimate the effect of user fee removal up to five years after the policy change. We used data from the birth histories of two nationally representative Demographic and Health Surveys to implement a difference-in-differences analysis and identify the causal impact of removing user charges on institutional and assisted deliveries, caesarean sections and neonatal deaths. We also explored heterogeneous effects of the policy. Removing fees had little effect in the short term but large positive effects appeared about two years after the policy change. Institutional deliveries in treated areas increased by 10 and 15 percentage points in peri-urban and rural districts respectively (corresponding to a 25 and 35 percent change), driven entirely by a reduction in home births. However, there was no evidence that the reform changed the behaviours of women with lower education, the proportion of caesarean sections or reduced neonatal mortality. Institutional deliveries increased where care quality was high, but not where it was low. While abolishing user charges may reduce financial hardship from healthcare payments, it does not necessarily improve equitable access to care or health outcomes. Shifting away from user fees is a necessary but insufficient step towards universal health coverage, and concurrent reforms are needed to target vulnerable populations and improve quality of care.
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影响因子：
2.2
作者：
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DOI：
10.1016/j.socscimed.2010.05.025
发表时间：
2010-08-01
期刊：
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影响因子：
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作者：
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DOI：
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发表时间：
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影响因子：
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影响因子：
2.3
作者：
David Zombré;M. De Allegri;R. Platt;V. Ridde;K. Zinszer
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