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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DOI：
10.1016/j.ssmph.2022.101051
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Chansa C
中科院分区：
文献类型：
--
作者：
Lagarde M;Lépine A;Chansa C
由于许多国家的妇女由于财政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。我们利用赞比亚从2006年起取消用户费的交错来估计政策改变后五年内取消用户费的影响。我们使用了两个具有全国代表性的人口与健康调查的出生历史数据，进行了差异分析，并确定了取消用户费用对机构和辅助分娩，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性影响。取消收费在短期内影响不大，但在政策改变后大约两年内出现了巨大的积极影响。接受治疗地区的住院分娩率在城市周边和农村地区分别增加了10和15个百分点（相当于25%和35%的变化），这完全是由于在家分娩的减少。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、剖腹产的比例或新生儿死亡率的降低。在护理质量高的地方，住院分娩增加，但在护理质量低的地方，则没有增加。虽然取消用户收费可能会减少医疗保健支付的经济困难，但它不一定会改善公平获得医疗保健或健康结果的机会。放弃用户付费是实现全民医保的必要但不够的一步，需要同时进行改革，以针对弱势群体并提高护理质量。取消用户收费增加了政策改变后2年孕妇的医疗保健使用。在免费护理设施中分娩的妇女比例增加了25-35%。受教育程度较低的妇女没有从改革中受益。我们发现剖腹产率或新生儿死亡率没有变化。
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. Removing user charges increased healthcare use of pregnant women 2 years after the policy change. The proportion of women delivering in facilities increased by 25–35% where care was free. Women with lower educations did not benefit from the reform. We find no change in C-section rates or neonatal mortality.
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通讯作者：
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DOI：
10.1016/s2214-109x(18)30386-3
发表时间：
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期刊：
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DOI：
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发表时间：
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期刊：
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