The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence?
OBJECTIVE: To assess the effects of user charges on the uptake of health services in low- and middle-income countries. METHODS: A systematic search of 25 social science, economics and health literature databases and other sources was performed to identify and appraise studies on the effects of intro...
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| Format: | Article |
| Language: | English |
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The World Health Organization
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| Series: | Bulletin of the World Health Organization |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862008001100013&lng=en&tlng=en |
| _version_ | 1797285580880478208 |
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| author | Mylene Lagarde Natasha Palmer |
| author_facet | Mylene Lagarde Natasha Palmer |
| author_sort | Mylene Lagarde |
| collection | DOAJ |
| description | OBJECTIVE: To assess the effects of user charges on the uptake of health services in low- and middle-income countries. METHODS: A systematic search of 25 social science, economics and health literature databases and other sources was performed to identify and appraise studies on the effects of introducing, removing, increasing or reducing user charges on the uptake of various health services in low- and middle-income countries. Only experimental or quasi-experimental study designs were considered: cluster randomized controlled trials (C-RCT), controlled " before and after" (CBA) studies and interrupted time series (ITS) studies. Papers were assessed in which the effect of the intervention was measured in terms of changes in service utilization (including equity outcomes), household expenditure or health outcomes. FINDINGS: Sixteen studies were included: five CBA, two C-RCT and nine ITS. Only studies reporting effects on health service utilization, sometimes across socioeconomic groups, were identified. Removing or reducing user fees was found to increase the utilization of curative services and perhaps preventive services as well, but may have negatively impacted service quality. Introducing or increasing fees reduced the utilization of some curative services, although quality improvements may have helped maintain utilization in some cases. When fees were either introduced or removed, the impact was immediate and abrupt. Studies did not adequately show whether such an increase or reduction in utilization was sustained over the longer term. In addition, most of the studies were given low-quality ratings based on criteria adapted from those of the Cochrane Collaboration's Effective Practice and Organisation of Care group. CONCLUSIONS: There is a need for more high-quality research examining the effects of changes in user fees for health services in low- and middle-income countries. |
| first_indexed | 2024-03-07T18:04:14Z |
| format | Article |
| id | doaj.art-1d570ab5361d4cbebf264766927ae01d |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T18:04:14Z |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-1d570ab5361d4cbebf264766927ae01d2024-03-02T09:36:05ZengThe World Health OrganizationBulletin of the World Health Organization0042-96868611839848C10.1590/S0042-96862008001100013S0042-96862008001100013The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence?Mylene Lagarde0Natasha Palmer1London School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineOBJECTIVE: To assess the effects of user charges on the uptake of health services in low- and middle-income countries. METHODS: A systematic search of 25 social science, economics and health literature databases and other sources was performed to identify and appraise studies on the effects of introducing, removing, increasing or reducing user charges on the uptake of various health services in low- and middle-income countries. Only experimental or quasi-experimental study designs were considered: cluster randomized controlled trials (C-RCT), controlled " before and after" (CBA) studies and interrupted time series (ITS) studies. Papers were assessed in which the effect of the intervention was measured in terms of changes in service utilization (including equity outcomes), household expenditure or health outcomes. FINDINGS: Sixteen studies were included: five CBA, two C-RCT and nine ITS. Only studies reporting effects on health service utilization, sometimes across socioeconomic groups, were identified. Removing or reducing user fees was found to increase the utilization of curative services and perhaps preventive services as well, but may have negatively impacted service quality. Introducing or increasing fees reduced the utilization of some curative services, although quality improvements may have helped maintain utilization in some cases. When fees were either introduced or removed, the impact was immediate and abrupt. Studies did not adequately show whether such an increase or reduction in utilization was sustained over the longer term. In addition, most of the studies were given low-quality ratings based on criteria adapted from those of the Cochrane Collaboration's Effective Practice and Organisation of Care group. CONCLUSIONS: There is a need for more high-quality research examining the effects of changes in user fees for health services in low- and middle-income countries.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862008001100013&lng=en&tlng=en |
| spellingShingle | Mylene Lagarde Natasha Palmer The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? Bulletin of the World Health Organization |
| title | The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? |
| title_full | The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? |
| title_fullStr | The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? |
| title_full_unstemmed | The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? |
| title_short | The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? |
| title_sort | impact of user fees on health service utilization in low and middle income countries how strong is the evidence |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862008001100013&lng=en&tlng=en |
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