To What Extent Do Free Healthcare Policies and Performance-Based Financing Reduce Out-Of-Pocket Expenditures for Outpatient services? Evidence From a Quasi-Experimental Study in Burkina Faso

被引:3
作者
Aye, Thit Thit [1 ]
Nguyen, Hoa Thi [2 ,3 ]
Brenner, Stephan [1 ]
Robyn, Paul Jacob [4 ]
Tapsoba, Ludovic Deo Gracias [5 ]
Lohmann, Julia [1 ,6 ]
De Allegri, Manuela [1 ]
机构
[1] Heidelberg Univ, Heidelberg Inst Global Hlth, Med Fac, Heidelberg, Germany
[2] Heidelberg Univ, Heidelberg Inst Global Hlth, Med Fac, Heidelberg, Germany
[3] Heidelberg Univ, Med Fac, Div Trop Med, Heidelberg, Germany
[4] World Bank, Hlth Nutr & Populat Global Practice, Washington, DC USA
[5] Natl Inst Publ Hlth, Ouagadougou, Burkina Faso
[6] London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England
关键词
Out-of-Pocket Expenditures; User Fee Removal; Performance-Based Financing; Burkina Faso; INCREASE UTILIZATION; IMPLEMENTATION; CHILDREN;
D O I
10.34172/ijhpm.2022.6767
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Burkina Faso has been implementing financing reforms towards Universal Health Coverage since 2006. Recently, the country introduced a performance-based financing program (PBF) as well as user fee removal (gratuite) policy for health services aimed at pregnant and lactating women and children under five. We aim to assess the effect of gratuite and PBF policies on facility-based out-of-pocket expenditures (OOPE) for outpatient services.Methods: Our study is a controlled pre-and post-test design using healthcare facility data from the PBF program's impact evaluation collected in 2014 and 2017. We compared OOPE related to primary healthcare use incurred by children under five and individuals above five to assess the effect of the gratuite policy on OOPE. We further compared OOPE incurred by individuals residing in PBF districts and non-PBF districts to estimate the effect of the PBF on OOPE. Effects were estimated using difference-in-differences (DID) models, distinguishing the estimation of the probability of incurring OOPE from the estimation of the magnitude of OOPE using a generalized linear model (GLM).Results: The proportion of children under five incurring OOPE declined significantly from 90% in 2014 to 3% in 2017. Concurrently, mean OOPE also decreased. Differences in both the probability of incurring OOPE and mean OOPE between PBF and non-PBF facilities were small. Our DID estimates indicated that gratuite produced an 84% (CI-86%,-81%) reduction in the probability of incurring OOPE and reduced total OOPE by 54% (CI 63%, 42%). We detected no significant effects of PBF, either in reducing the probability of incurring OOPE or in its magnitude.Conclusions: User fee removal is an effective demand-side intervention for enhancing financial accessibility. As a supply-side intervention, PBF appears to have limited effects on reducing financial burden.
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页数:11
相关论文
共 75 条
[1]   Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in sub-Saharan Africa: A multilevel modelling of Demographic and Health Surveys [J].
Ahinkorah, Bright Opoku ;
Budu, Eugene ;
Seidu, Abdul-Aziz ;
Agbaglo, Ebenezer ;
Adu, Collins ;
Ameyaw, Edward Kwabena ;
Ampomah, Irene Gyamfuah ;
Archer, Anita Gracious ;
Kissah-Korsah, Kwaku ;
Yaya, Sanni .
PLOS ONE, 2021, 16 (02)
[2]   Examining barriers to healthcare access and utilization of antenatal care services: evidence from demographic health surveys in sub-Saharan Africa [J].
Ahinkorah, Bright Opoku ;
Ameyaw, Edward Kwabena ;
Seidu, Abdul-Aziz ;
Odusina, Emmanuel Kolawole ;
Keetile, Mpho ;
Yaya, Sanni .
BMC HEALTH SERVICES RESEARCH, 2021, 21 (01)
[3]   Out-of-pocket payment for surgery in Uganda: The rate of impoverishing and catastrophic expenditure at a government hospital [J].
Anderson, Geoffrey A. ;
Ilcisin, Lenka ;
Kayima, Peter ;
Abesiga, Lenard ;
Benitez, Noralis Portal ;
Ngonzi, Joseph ;
Ronald, Mayanja ;
Shrime, Mark G. .
PLOS ONE, 2017, 12 (10)
[4]  
Angrist JD, 2009, MOSTLY HARMLESS ECONOMETRICS: AN EMPIRICISTS COMPANION, P3
[5]  
[Anonymous], 2011, Programa de Mejora de la Raza de Lidia, P1
[6]  
Asante Fa, 2007, Ghana Med J, V41, P110
[7]  
Barber J, 2004, MULTIPLE REGRESSION, V9
[8]  
Barroy H., 2018, Transition to Programme Budgeting in Health in Burkina Faso: Status of the Reform and Preliminary Lessons for Health Financing
[9]   Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso [J].
Beauge, Yvonne ;
Ridde, Valery ;
Bonnet, Emmanuel ;
Souleymane, Sidibe ;
Kuunibe, Naasegnibe ;
De Allegri, Manuela .
HEALTH ECONOMICS REVIEW, 2020, 10 (01)
[10]   Do Targeted User Fee Exemptions Reach the Ultra-Poor and Increase their Healthcare Utilisation? A Panel Study from Burkina Faso [J].
Beauge, Yvonne ;
De Allegri, Manuela ;
Ouedraogo, Samiratou ;
Bonnet, Emmanuel ;
Kuunibe, Naasegnibe ;
Ridde, Valery .
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 2020, 17 (18) :1-21