ABSTRACT
One approach to delivering healthcare in developing countries is through voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health care. Using inclusion/exclusion criteria, a search of databases, key journals and websites review was conducted in October 2010. A narrative synthesis approach was taken to summarise and analyse five outcome categories: targeting, utilisation, cost efficiency, quality and health outcomes. Sub-group and sensitivity analyses were also performed. A total of 24 studies evaluating 16 health voucher programmes were identified. The findings from 64 outcome variables indicates: modest evidence that vouchers effectively target specific populations; insufficient evidence to determine whether vouchers deliver healthcare efficiently; robust evidence that vouchers increase utilisation; modest evidence that vouchers improve quality; no evidence that vouchers have an impact on health outcomes; however, this last conclusion was found to be unstable in a sensitivity analysis. The results in the areas of targeting, utilisation and quality indicate that vouchers have a positive effect on health service delivery. The subsequent link that they improve health was found to be unstable from the data analysed; another finding of a positive effect would result in robust evidence. Vouchers are still new and the number of published studies is limiting.
Subject(s)
Developing Countries , Medical Assistance/organization & administration , Cost-Benefit Analysis , Humans , Marketing of Health Services , Medical Assistance/economics , Medical Assistance/statistics & numerical data , Outcome Assessment, Health Care , Patient Acceptance of Health CareABSTRACT
Se han hecho recomendaciones contradictorias con respecto a si las madres VIH positivas deben amamantar. Debido a que los paises en desarrollo suelen imitar las prácticas estadounidenses para la alimentación de los lactantes, se creó un modelo para calcular la mortalidad infantil en regiones menos desarrolladas, donde se observa la advertencia de los Centros de los EE.UU. para el control de Enfermedades de que las madres VIH positivas no deben amamantar. En este modelo se dan estimaciones para la mortalidad infantil con y sin lactancia materna, en varios niveles de referencia y de tasas teóricas de transmisión por medio de la lactancia. Se considera que la mortalidad infantil asociada con la infección por el VIH contraída a travez de la leche materna, es más baja que la mortalidad asociada con las enfermedades de la infancia que resultarían de suspender la leche materna. La diferencia entre estas apreciaciones es mayor en las zonas que presentan niveles altos de mortalidad infantil.
