The User Fee Introduction and Its Effect in the Health System of Low and Middle Income Countries: An Exploratory Study Using Realist Review Method / 보건행정학회지

BACKGROUND: The purpose of this exploratory study is to explain where, when and how the introduction of user fee system works in low and middle income countries using context, mechanism, and outcome configuration. METHODS: Considering advanced research in realist review approach, we made a review process including those following 4 steps. They are identifying the review question, initial theory and mechanism, searching and selecting primary studies, and extracting, analyzing, and synthesizing relevant data. RESULTS: User fee had a detrimental effect on medical utilization in low and middle income countries. Also previous and current interventions and community participation were critical context in user fee system. Those contexts were associated with intervention initiation and recognition and coping strategies. Such contexts and mechanisms were critical explanatory factors in medical utilization. CONCLUSION: User fee is a series of interventions that are fragile and dynamic. So the introduction of user fee system needs a comprehensive understanding of previous and new intervention, policy infrastructure, and other factors that can influence on medical utilization.

Choice of health-care facility after introduction of free essential health services in Nepal

Background: Choice of health‑care services depends on patients’ characteristics and the features of health‑care facilities available. In Nepal, a significant proportion of health care is provided through the private sector, despite the introduction of free essential health care for all citizens in 2008. We sought to determine whether people chose private or public facilities in the first instance for acute health problems. We also assessed the reasons for their choice. Materials and Methods: A cross‑sectional survey was done by use of a questionnaire administered to 400 household heads in Jhapa district, Nepal. Results: 272 (68%) respondents sought treatment from public health‑care facilities in the first instance. On adjusted analysis, illiterate people were more likely to choose public facilities than people with higher secondary education (OR 5.47, P = 0.002). Similarly, lower‑caste and religious‑minority respondents were more likely to choose public facilities than disadvantaged janajati (OR 2.33, P = 0.01). Among respondents who used public facilities, 174 (64.0%) and 109 (40.0%) stated that that their choice was based on financial accessibility and physical accessibility, respectively. Among respondents who used private facilities, 65 (50.7%) and 54 (42.1%) said their choice was based on adequacy of resources/services and health‑care delivery, respectively. Conclusion: A substantial portion of respondents used public health‑care facilities in the first instance, mainly because of financial and physical accessibility rather than adequacy of resources or better health‑care delivery. These results may indicate a positive impact of removal of user fees for public health‑care facilities in Nepal, especially for impoverished people.

The impact of a no-user-fee policy on the quality of patient care/service delivery in Jamaica / Impacto de una política de gratuidad para el usuario sobre la calidad de la atención al paciente y la prestación de servicios

This paper is a submission to the Sessional Select Committee on Human Resources and Social Development by the Medical Association of Jamaica on September 25, 2011, and presented orally by both authors on October 20, 2011. It explores the impact of the no-user-fee policy on the quality of patient care/service delivery in Jamaica and makes recommendations for reform.

Este trabajo es una presentación al llamado Sessional Select Committee en torno a los Recursos Humanos y el Desarrollo Social, realizada por la Asociación Médica de Jamaica el 25 de septiembre de 2011, presentada oralmente por ambos autores el 20 de octubre de 2011. Explora el impacto de una política de gratuidad para el usuario sobre la calidad de la atención al paciente y la prestación de servicios y hace recomendaciones en cuanto a realizar reformas.

Factors Influencing People’s Willingness-to-buy Insecticide-treated Bednets in Arbaminch Zuria District, Southern Ethiopia.

Promoting self-financing healthcare helps restore efficiency and equity to national health systems. This study was conducted in malaria-endemic areas of southern Ethiopia to assess the bednet possession of the community, determine the people’s willingness-to-pay for insecticide-treated bednets (ITNs), and identify what factors influence it. The study provided relevant information for programme planners and policymakers for evidence-based decision-making. This quantitative cross-sectional community-based study was conducted in four selected malarious Kebeles of Arbaminch Zuria district using a pretested interview-administered structured questionnaire. In total, 982 household heads were interviewed. The community’s willingness-to-pay was assessed by contingent valuation technique using binary with follow-up method. The advantage, the distribution, and the payment mechanism were explained, and three different qualities of ITN were shown by constructing a hypothetical market scenario. Of the 982 respondents, 466 (47.5%) households had at least one functional bednet. Of 849 children aged less than five years in the 982 households, 185 (21.8%) slept under a net the night preceding the survey. The results of the study revealed that around 86% of the respondents were willing to buy ITNs. The average maximum willingness-to-pay for three different types of bednets was statistically different. The maximum amount the people were willing to pay was US$ 3.3 for a blue conical ITN, US$ 3.2 for a white conical one, and US$ 1.7 for a blue rectangular ITN. The community’s willingness-to-pay was significantly affected by gender, educational status, perceived benefit of ITN, previous source of bednet, and characteristics of bednet. The results showed that a significant proportion of the community people were willing to pay for ITNs. Therefore, introducing a subsidized ITN market rather than free distribution for all should be considered to ensure sustainability and self-reliance in the prevention and control of malaria.