USER FEES PLUS QUALITY EQUALS IMPROVED ACCESS TO HEALTH-CARE - RESULTS OF A FIELD EXPERIMENT IN CAMEROON
USER FEES PLUS QUALITY EQUALS IMPROVED ACCESS TO HEALTH-CARE - RESULTS OF A FIELD EXPERIMENT IN CAMEROON
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DOI：
10.1016/0277-9536(93)90267-8
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发表时间：
1993-08-01
影响因子：
5.4
通讯作者：
BODART, C
中科院分区：
文献类型：
--
作者：
LITVACK, JI;BODART, C
自1988年发起巴马科倡议以来，许多非洲国家开始实施综合初级保健方案，至少部分依靠通过用户收费产生的收入来振兴保健服务系统。虽然这些方案包含两个关键组成部分，即使用费和提高质量，但政策辩论往往侧重于前者，而忽视后者。本研究的目的是提供一个净评估的这两个组成部分，通过测试如何使用者的费用和质量的提高影响卫生设施的利用在总人口，特别是在最贫穷的人。一个“前测后测控制”的实验进行了5个公共卫生设施在阿达马瓦省的喀麦隆。三个保健中心，采用了用户费和质量改进（即可靠的药物供应）的政策被选为“治疗"中心和两个类似的设施尚未逐步采用这一政策被选为”控制“。进行了两轮家庭调查（每轮调查针对五个研究点周围25个村庄的800户家庭），以衡量在政策实施前后到保健中心寻求治疗的病人的百分比。通过每月在每个研究地点进行观察，对实验进行严格控制。结果表明，与“对照”地区的人相比，“治疗”地区的人使用健康中心的概率显着增加。寻求其他保健来源所需的旅费和时间成本很高;当当地保健中心有优质药品时，保健和治疗费用实际上降低了保健价格，从而提高了利用率。此外，与以前的研究发现，最贫穷的五分之一人口受到使用费的伤害最大相反，这项研究发现，最贫穷的五分之一人口寻求保健的可能性以比其他人口更大的比例增加。由于穷人对价格变化的反应最大，他们似乎比其他人更能从当地的药品供应中受益。
Since the Bamako Initiative was launched in 1988, many African countries have embarked on comprehensive primary health care programs relying, at least partially, on revenues generated through user fees to revitalize health care delivery systems. Although these programs contain two critical components, user fees and improved quality, policy debates have tended to focus on the former and disregarded the latter. The purpose of this study is to provide a net assessment of these two components by testing how user fees and improved quality affect health facility utilization among the overall population and specifically among the poorest people.A ''pretest-posttest controlled'' experiment was conducted in five public health facilities in the Adamaoua province of Cameroon. Three health centers which were to introduce a user fee and quality improvement (i.e. reliable drug supply) policy were selected as ''treatment'' centers and two comparable facilities not yet phased into this policy were selected as ''controls''. Two rounds of household surveys were conducted (each to 800 households in 25 villages surrounding the five study sites) to measure the percentage of ill people seeking care at the health center before and after the implementation of the policy. The experiment was tightly controlled by conducting monthly observations at each study site.Results indicate that the probability of using the health center increased significantly for people in the ''treatment'' areas compared to those in the ''control'' areas. Travel and time costs involved in seeking alternative sources of care are high; when good quality drugs became available at the local health center, the fee charged for care and treatment represented an effective reduction in the price of care and thus utilization rose. Moreover, contrary to previous studies which have found that the poorest quintile is most hurt by user fees, this study found that probability of the poorest quintile seeking care increases at a rate proportionately greater than the rest of the population. Since the poor are most responsive to price changes, they appear to be benefitting from local availability of drugs more than others.