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    Jan 16, 2021
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    Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study

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    Maini R - 2014 - Picking up the ...
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    Authors
    Maini, R
    Van den Bergh, R
    van Griensven, J
    Tayler-Smith, K
    Ousley, J
    Carter, D
    Mhatre, S
    Ho, L
    Zachariah, R
    Issue Date
    2014-11-05
    
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    Journal
    BMC Health Services Research
    Abstract
    BackgroundUser fees have been shown to constitute a major barrier to the utilisation of health-care, particularly in low-income countries such as the Democratic Republic of Congo (DRC). Importantly, such barriers can lead to the exclusion of vulnerable individuals from health-care. In 2008, a donor-funded primary health-care programme began implementing user fee subsidisation in 20 health zones of the DRC. In this study, we quantified the short and long-term effects of this policy on health-care utilisation.MethodsSixteen health zones were included for analysis. Using routinely collected health-care utilisation data before and after policy implementation, interrupted time series regression was applied to quantify the temporal impact of the user fee policy in the studied health zones. Payment of salary supplements to health-care workers and provision of free drugs - the other components of the programme - were controlled for where possible.ResultsFourteen (88%) health zones showed an immediate positive effect in health-care utilisation rates (overall median increase of 19%, interquartile range 11 to 43) one month after the policy was introduced, and the effect was significant in seven zones (P <0.05). This initial effect was sustained or increased at 24 months in five health zones but was only significant in one health zone at P <0.05. Utilisation reduced over time in the remaining health zones (overall median increase of 4%, interquartile range ¿10 to 33). The modelled mean health-care utilisation rate initially increased significantly from 43 consultations/1000 population to 51 consultations/1000 population during the first month following implementation (P <0.01). However, the on-going effect was not significant (P =0.69).ConclusionsOur research brings mixed findings on the effectiveness of user fee subsidisation as a strategy to increase the utilisation of services. Future work should focus on feasibility issues associated with the removal or reduction of user fees and how to sustain its effects on utilisation in the longer term.
    Publisher
    BioMed Central
    URI
    http://hdl.handle.net/10144/336619
    DOI
    10.1186/s12913-014-0504-6
    PubMed ID
    25370385
    Language
    en
    ISSN
    1472-6963
    ae974a485f413a2113503eed53cd6c53
    10.1186/s12913-014-0504-6
    Scopus Count
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    Operational Research Courses

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