Increasing the uptake of health services in low-income countries: What can we expect from user fee removal and financial incentives?

提高低收入国家卫生服务的普及率：我们对使用费免除和财政激励措施有何期望？

• 批准号: MR/L012057/1
• 负责人: Aurelia Lepine
• 金额: $ 37.95万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2014
• 资助国家: 英国
• 起止时间: 2014 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FL012057%2F1
• 关键词: Increasing; uptake; health; services; low

Increasing the uptake of health services by the poorest and most vulnerable populations is required to improve health outcomes and more ultimately to alleviate poverty. Over the last decades, there have been many changes regarding the perception of the main predictors of health services uptake in low-income countries. User fees were introduced in most of African countries in the late 80's based on the idea that even the poorest individuals had some ability to pay for health, especially if the quality of care is high. More recently low-income countries have implemented several policies such as user fee removal, universal health insurance and financial incentives in order to improve health care use of the poorest populations. Although those new health policies have provided researchers with an unique opportunity to explore the role of income on health services uptake, the use of inappropriate methods to analyse impacts or the poor design and external validity of RCTs conducted in this area has failed to provide some evidence on the impact and transmission channels through which those policies indirectly affecting income affects health service uptake. I propose to undertake a comprehensive and original programme of research to address this gap in knowledge. Using advanced econometric techniques the research will first investigate the impact of income and health facilities' characteristics on health care use in four low-income countries. Then, I will investigate the effect of user fee removal in Zambia on access, out-of-pocket medical expenses and on economic vulnerability. Finally, I will investigate the effect of income for patients with different levels of risk aversion on adherence to PrEP among HIV sero-discordant couples in Nigeria. To do so, I plan to develop a small research project part of the PrEP demonstration project that will be implemented in Nigeria and will aim to investigate the determinants of adherence to PrEP in Nigeria. The findings regarding the determinants of PrEP adherence will be used to design a RCT that will highlight the optimal amount and the best manner to allocate the financial incentive (cash payment versus lottery) to maximise its effects on adherence to PrEP. The MRC early career fellowship in economics of health will thus provide for the publication of a series of papers on the role of income in the uptake of curative and preventive health services in low-income countries. The results of this research will be disseminated to an academic audience and to policy-makers through presentations, seminars and conferences. The production of this proposal will be supported by a series of training modules in impact evaluation econometric techniques and impact evaluation design.

必须增加最贫穷和最脆弱人口对保健服务的利用，以改善保健成果，并最终减轻贫穷。在过去几十年中，对低收入国家保健服务利用的主要预测因素的看法发生了许多变化。大多数非洲国家在80年代后期采用了使用者付费，其依据是，即使是最贫穷的个人也有一定的能力支付保健费用，特别是在保健质量很高的情况下。最近，低收入国家实施了若干政策，如取消使用费、全民医疗保险和财政奖励，以改善最贫穷人口的保健利用。虽然这些新的卫生政策为研究人员提供了一个独特的机会，探讨收入对卫生服务吸收的作用，使用不适当的方法来分析影响或在这一领域进行的随机对照试验的设计和外部效度差，未能提供一些证据的影响和传播渠道，通过这些政策间接影响收入影响卫生服务的吸收。我建议开展一项全面和原创的研究计划，以解决这一知识差距。利用先进的计量经济学技术，该研究将首先调查收入和卫生设施的特点对四个低收入国家的卫生保健使用的影响。然后，我将调查在赞比亚的访问，自付医疗费用和经济脆弱性的用户费取消的影响。最后，我将调查收入的影响，患者不同程度的风险厌恶坚持在尼日利亚艾滋病毒血清不一致的夫妇之间的PrEP。要做到这一点，我计划开发一个小的研究项目部分的准备示范项目，将在尼日利亚实施，并将旨在调查坚持准备在尼日利亚的决定因素。关于PrEP依从性决定因素的研究结果将用于设计一项RCT，该RCT将突出分配财务激励的最佳金额和最佳方式（现金支付与彩票）因此，MRC健康经济学早期职业奖学金将提供一系列关于收入在治疗和预防健康方面的作用的论文的出版。低收入国家的服务。这项研究的结果将通过介绍会、研讨会和会议向学术界和决策者传播。这一建议的编制将得到一系列关于影响评价计量经济学技术和影响评价设计的培训单元的支持。

项目成果

The long-term effects of free care on birth outcomes: Evidence from a national policy reform in Zambia

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
• 发表时间: 2021
• 作者: Lagarde M

Investigating interventions to increase uptake of HIV testing and linkage into care or prevention for male partners of pregnant women in antenatal clinics in Blantyre, Malawi: study protocol for a cluster randomised trial.

• DOI: 10.1186/s13063-017-2093-2
• 发表时间: 2017-07-24
• 期刊: Trials
• 影响因子: 2.5
• 作者: Choko AT;Fielding K;Stallard N;Maheswaran H;Lepine A;Desmond N;Kumwenda MK;Corbett EL
• 通讯作者: Corbett EL

Women's Empowerment and Wellbeing: Evidence from Africa

• DOI: 10.1080/00220388.2016.1219345
• 发表时间: 2017-01-01
• 期刊: JOURNAL OF DEVELOPMENT STUDIES
• 影响因子: 2.9
• 作者: Fielding, David;Lepine, Aurelia
• 通讯作者: Lepine, Aurelia

DETERMINANTS OF CROP YIELD AND PROFIT OF FAMILY FARMS: EVIDENCE FROM THE SENEGAL RIVER VALLEY

家庭农场作物产量和利润的决定因素：来自塞内加尔河谷的证据

• DOI: 10.1017/s0014479714000581
• 发表时间: 2015
• 期刊: Experimental Agriculture
• 影响因子: 1.6
• 作者: BLANC E

The long-term effects of free care on birth outcomes: Evidence from a national policy reform in Zambia.

• DOI: 10.1016/j.ssmph.2022.101051
• 发表时间: 2022-03
• 期刊: SSM - population health
• 作者: Lagarde M;Lépine A;Chansa C
• 通讯作者: Chansa C