EFFECTS OF USER FEES EXEMPTION ON RURAL HOUSEHOLDS HEALTH SPENDING

Buregeya Etienne, Mahender Singh

Abstract


In response to unexpected effects of user fees recovery, the government introduced user fees exemption policy in May 2006 in all government and allied healthcare facilities. The policy was coupled with performance based financing in 2010. According to this policy, outpatients and inpatients children aged between 0 to 59 months and pregnant women pay zero fees for curative consultation and admission. And any admitted children under the aged of five or pregnant women can only spend two days of admission at any local health centers. The paper empirically evaluates the outcomes of the implementation of this policy. The paper argues that rather than paying zero fees, both beneficiaries are paying high prices for consultations and admissions in the public and private sectors. For example during the period of our study(July 2017 till July 2018), (68.5%) outpatient pregnant women have paid out-of-pocket money while 55% admitted pregnant women have also paid out-of-pocket money at their local government health centers. And 31% outpatients children under five years of age have paid out-of-pocket money whereas 38.5% admitted children under five year of age have also paid out-of-pocket money at their local government health centers.

Keywords


User fees recovery, User fees exemption, Rural household, Health spending, Rural health spending, Rural spending.

References


Akin JS. (2001). “Financing health services in developing countries. An Agenda for Reform”, A World Bank Policy Study. PUB-6563, available online: http://documents.worldbank.org/curated/en/468091468137379607/Financing-health-services-in-developing-countries-an-agenda-for-reform

Gilson L. (1997). “The lessons of user fee experience in Africa”, Health Policy and Planning, Oxford University Press,Vol.12(4), pp.273-285.

Grittner AM. (2013). “Results-based Financing: Evidence from performance-based financing in the health sector”, Bonn, available online: https://www.die-gdi.de/en/discussion-paper/article/results-based-financing-evidence-from-performance-based-financing-in-the-health-sector/

Lagomarsino G, Garabrant A, Adyas A, Muga R, and Otoo N. (2012). “Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia”, Lancet, pp.933-943.

McIntyre D, Garshong B, Mtei G, Meheus F, Thiede M, Akazili J, Ally M, Aikins M, Mulligan JA, and Goudge J. (2008). “Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania”, Bulletin of the World Health Organization, Vol.86, pp.871-876.

Morgan L, and Eichler R. (2011). “Performance-based incentives in Sub-Saharan Africa: experiences, challenges, lessons”, Bethesda (MD): Health Systems 20/20, Abt Associates, Available online: http://pdf.usaid.gov/pdf_docs/pnadz294.pdf

Nimpagaritse M, and Bertone MP. (2011). “The sudden removal of user fees : the perspective of a frontline manager in Burundi”, Health Policy and Planning, Vol.26(suppl_2), November, pp.ii63–ii71, https://doi.org/10.1093/heapol/czr061

Pearson M. (2011). “Results based aid and results based financing: What are they? Have they delivered results?”, HLSP Institute, January.

Jean-Pierre Olivier de Sardan, Valéry Ridde. (nd). “L'exemption de paiement des soins au Burkina Faso, Mali et Niger. Les contradictions des politiques publiques”, Afrique.

Trémolet S. (2011). “Identifying the Potential for Results-Based Financing for Sanitation. Scaling Up Rural Sanitation”, November, available online: https://www.issuelab.org/resources/14575/14575.pdf

• Additional Bibliography

o Accès aux soins de sante au Burundi. (2004). “Résultats de trois enquêtes épidémiologiques", Médecins Sans Frontière, Mars 2004, available online : https://repositories.lib.utexas.edu/bitstream/handle/2152/5769/3037.pdf?sequence=1&isAllowed=y

o Burundi : Une santé chèrement payée. (2006). "La détention des patients sans ressources dans les hôpitaux burundais", Human Right Watch, Septembre.

o Hatt LE, Makinen M, Madhavan S, and Conlon CM. (2013). “Effects of User Fee Exemptions on the Provision and Use of Maternal Health Services: A Review of Literature”, J Health POPUL NUTR, Dec, Vol.31(4) Suppl 2, pp.S67-S80.

o http://www.healthfinancingafrica.org/home/category/accountability

o Lagarde M, and Palmer N. (2011). “The impact of user fees on access to health services in low and middle-income countries”, Cochrane Database Syst Rev, Apr 13, Vol.4, CD009094. doi: 10.1002/14651858.CD009094.

o Macinko J, Starfield B, and Erinosbo. (2009). “The Impact of Primary Healthcare on Population Health in Low- and Middle-Income Countries, J. Ambulatory Care Manage, Vol.32(2), pp.150-171.

o République du Benin, Impacts de la Gratuite des soins Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, and Rahman MH. (2008). “Poverty and Access to Health Care in Developing Countries”, Ann N Y Acad Sci, Vol.1136, pp.161-171.

o Ridde V, Queuille L, and Kafando Y. "Capitalisation de politiques publiques d’exemption du paiement des soins en Afrique de l’Ouest", available online : http://www.vesa-tc.umontreal.ca/pdf/2012/livre_CAPI.pdf.

o Samb OM, and Ridde V. (2012 ). “How to Ensure Effective and Selective Free Medical Care Burkina Faso Citizen Involvement in Beneficiary Selection”, Afrique contemporaine 2012/3 (n° 243), pp.33-48. DOI 10.3917/afco.243.0033

o The World Bank. (1987). “Financing Health Services in Developing Countries. An Agenda for Reform”, available online: http://documents.worldbank.org/curated/en/468091468137379607/Financing-health-services-in-developing-countries-an-agenda-for-reform.


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