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

点击翻译按钮获取中文摘要

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.