Understanding the Impact of Eliminating User Fees : Utilization and Catastrophic Health Expenditures in Uganda  

Oleh:

Ke Xu ; Evans, David B. ; Kadama, Patrick ; Nabyonga, Juliet

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Social Science & Medicine (www.elsevier.com/locate/sosscimed) vol. 62 no. 4 (Feb. 2006), page 866-876.
Topik: health; user charges; service utilization; catastrophic expenditure; uganda

Ketersediaan

Perpustakaan Pusat (Semanggi) Nomor Panggil: SS53.2 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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There is currently considerable discussion between governments, international agencies, bilateral donors and advocacy groups on whether user fees levied at government health facilities in poor countries should be abolished. It is claimed that this would lead to greater access for the poor and reduce the risks of catatstrophic health expenditures if all other factors remained constant, though other factors rarely remain constant in practice. Accordingly, it it improtant to understand what ahs actually happened when user fees have been abolished. and why. All fees at first level government health facilities in uganda were removed in march 2001. This study explores the impact on ehalth service utilization and catatstrophic health expenditures using data from national household surveys undertaken in 1997 , 2000 , and 2003. Utilizaton increased for the non poor but at a lower rate than it had in the period immediately before fees were abolished. Utilization among the poor increased much more rapidly after the abolition of fees than beforehand. Unexpectedly, the incidence of catatstrophic health expenditure among the poor did not fall. The most likely explanation is that frequent unavaibility of drugs at government facilities after 2001 forced patients to purchase from private pharmacies. Informal payments to health workers may also have increased to offset the lost revenue from fees. Countries thinking of removing user charges should first examine what types of activities and inputs at the facility level are funded from the revenue collected by fees, and then develop mechanisms to ensure that these activities can be sustained subsequently.

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