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The European Journal of Health Economics
Erschienen in: The European Journal of Health Economics 1/2015

01.01.2015 | Original Paper

The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso

verfasst von: V. Ridde, I. Agier, A. Jahn, O. Mueller, J. Tiendrebéogo, M. Yé, M. De Allegri

Erschienen in: The European Journal of Health Economics | Ausgabe 1/2015

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Abstract

Background

User fee removal policies have been extensively evaluated in relation to their impact on access to care, but rarely, and mostly poorly, in relation to their impact on household out-of-pocket (OOP) spending. This paucity of evidence is surprising given that reduction in household economic burden is an explicit aim for such policies. Our study assessed the equity impact on household OOP spending for facility-based delivery of the user fee reduction policy implemented in Burkina Faso since 2007 (i.e. subsidised price set at 900 Communauté Financière Africaine francs (CFA) for all, but free for the poorest). Taking into account the challenges linked to implementing exemption policies, we aimed to test the hypothesis that the user fee reduction policy had favoured the least poor more than the poor.

Methods

We used data from six consecutive rounds (2006–2011) of a household survey conducted in the Nouna Health District. Primary outcomes are the proportion of households being fully exempted (the poorest 20 % according to the policy) and the actual level of household OOP spending on facility-based delivery. The estimation of the effects relied on a Heckman selection model. This allowed us to estimate changes in OOP spending across socio-economic strata given changes in service utilisation produced by the policy.

Findings

A total of 2,316 women reported a delivery between 2006 and 2011. Average household OOP spending decreased from 3,827 CFA in 2006 to 1,523 in 2011, without significant differences across socio-economic strata, neither in terms of households being fully exempted from payment nor in terms of the amount paid. Payment remained regressive and substantially higher than the stipulated 900 CFA.

Conclusions

The Burkinabè policy led to a significant and sustained reduction in household OOP health spending across all socio-economic groups, but failed to properly target the poorest by ensuring a progressive payment system.
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Literatur
1.
Ridde, V., Morestin, F.: A scoping review of the literature on the abolition of user fees in health care services in Africa. Health Policy Plan 26(1), 1–11 (2011)PubMedCrossRef
2.
Rodin, J., De Ferranti, D.: Universal health coverage: the third global health transition? Lancet 380, 861–862 (2012)PubMedCrossRef
3.
Sambo, L., Kirigia, J., Ki-Zerbo, G.: Perceptions and viewpoints on proceedings of the Fifteenth Assembly of Heads of State and Government of the African Union Debate on Maternal, Newborn and Child Health and Development, 25–27 July 2010, Kampala Uganda. BMC Proc. 5(Suppl 5), S1 (2011)PubMedCentralPubMedCrossRef
4.
De Brouwere, V., Richard, F., Witter, S.: Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn. Trop. Med. Int. Health 15(8), 901–909 (2010)
5.
Gwatkin, D.: Ergo: universal health coverage: friend or foe of health equity? Lancet 377(9784), 2160–2161 (2011)PubMedCrossRef
6.
Castro-Leal, F., Dayton, J., Demery, L., Mehra, K.: Public spending on health care in Africa: do the poor benefit? Bull. World Health Organ. 78(1), 66–74 (2000)PubMedCentralPubMed
7.
8.
Dzakpasu, S., Powell-Jackson, T., Campbell, O.M.R.: Impact of user fees on maternal health service utilization and related health outcomes: a systematic review. (2013). Health Policy Plan. doi: 10.​1093/​heapol/​czs142
9.
Asante, F.A., Chikwama, C., Daniels, A., Armar-Klemesu, M.: Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in Ghana. Ghana Med. J. 41(3), 110–117 (2007)PubMedCentralPubMed
10.
De Allegri, M., Ridde, V., Louis, V., Sarker, M., Tiéndrebeogo, J., Ye, M., Müller, O., Jahn, A.: The impact of targeted subsidies for facility-based delivery on access to care and equity—evidence from a population-based study in rural Burkina Faso. J. Public Health Policy 33(4), 439–453 (2012)PubMedCrossRef
11.
12.
Xu, K., Evans, D.D., Kadama, P., Nabyonga, J., Ogwang Ogwal, P., Nabukhonzo, P., Aguilar, A.M.: Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc. Sci. Med. 62, 866–876 (2006)PubMedCrossRef
13.
Nabyonga Orem, J., Mugisha, F., Kirunga, C., Macq, J., Criel, B.: Abolition of user fees: the Uganda paradox. Health Policy Plan 26(Suppl 2), 41–51 (2011)
14.
Deininger, K., Mpuga, P.: Economic and welfare impact of the abolition of health user fees: evidence from Uganda. J. Afr. Econ. 14(1), 55–91 (2005)CrossRef
15.
Sié, A., Louis, V., Gbangou, A., Muller, O., Niamba, L., Stieglbauer, G., Yé, M., Kouyaté, B., Saueborn, R., Becher, H.: The Health and Demographic Surveillance System (HDSS) in Nouna, Burkina Faso, 1993–2007. Glob. Health Action 3(5284), 5284 (2010)
16.
Ministère de la Santé: Stratégie nationale de subvention des accouchements et des soins obstétricaux et néonataux d’urgence au Burkina Faso, p. 65. Ministère de la Santé, Ouagadougou (2006)
17.
Ridde, V., Richard, F., Bicaba, A., Queuille, L., Conombo, G.: The national subsidy for deliveries and emergency obstetric care in Burkina Faso. Health Policy Plan 26(Suppl 2), ii30–ii40 (2011)PubMed
18.
19.
Victora, C.G., Vaughan, J.P., Barros, F.C., Silva, A.C., Tomasi, E.: Explaining trends in inequities: evidence from Brazilian child health studies. Lancet 356(9235), 1093–1098 (2000)PubMedCrossRef
20.
De Allegri, M., Louis, V., Tiendrébeogo, J., Souares, A., Yé, M., Tozan, Y., Jahn, A., Mueller, O.: Moving towards universal coverage with malaria control interventions: achievements and challenges in rural Burkina Faso. Int. J. Health Plan. Manag. 28(1), 102–121 (2012)CrossRef
21.
De Allegri, M., Ridde, V., Louis, V.R., Sarkera, M., Tiendrebéogoc, J., Yé, M., Müller, O., Jahn, A.: Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso. Health Policy 99(3), 210–218 (2010)PubMedCrossRef
22.
23.
Milligan, P., Nije, A., Bennett, S.: Comparison of two cluster sampling methods for health surveys in developing countries. Int. J. Epidemiol. 33(3), 476–496 (2004)CrossRef
24.
Hausman, J.: Sample selection bias as a specification error. Econometrica 47, 153–161 (1979)CrossRef
25.
Filmer, D., Pritchett, L.H.: Estimating wealth effects without expenditure data–or tears: an application to educational enrolments in states of India. Demography 38(1), 115–132 (2001)PubMed
26.
Su, T., Pokhrel, S., Gbangou, A., Flessa, S.: Determinants of household health expenditure on western institutional health care. Eur. J. Health Econ. 7(3), 199–207 (2006)PubMedCrossRef
27.
Hajizadeh, M., Nghiem, H.: Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments? Int. J. Health Care Finance Econ. 11(4), 267–285 (2011)PubMedCrossRef
28.
Heckman, J.: Sample selection bias as a specification error. Econometrica 47, 153–161 (1979)CrossRef
29.
Su, T., Flessa, S.: Determinants of household direct and indirect costs: an insight for health-seeking behaviour in Burkina Faso. Euro. J. Health Econ. 14(1), 75–84 (2013)CrossRef
30.
Wirtz, V., Santa-Ana-Tellez, Y., Servan-Mori, E., Avila-Burgos, L.: Heterogeneous effects of health insurance on out-of-pocket expenditure on medicines in Mexico. Value Health. 15(5), 593–603 (2012)PubMedCrossRef
31.
Porterfield, S., DeRigne, L.: Medical home and out-of-pocket medical costs for children with special health care needs. Pediatrics 128(5), 892–900 (2011)PubMedCrossRef
32.
Ridde, V., Queuille, L., Atchessi, N., Samb, O., Heinmüller, R., Haddad, S.: A user fees abolition experimentation evaluation for vulnerable groups in Burkina Faso. Field Actions Sci. Rep. Special Issue 8 (2012). http://​factsreports.​revues.​org/​1758
33.
Ridde, V., Diarra, A.: A process evaluation of user fees abolition for pregnant women and children under five years in two districts in Niger (West Africa). BMC Health Serv. Res. 9, 89 (2009)PubMedCentralPubMedCrossRef
34.
35.
Witter, S., Dieng, T., Mbengue, D., Moreira, I., de Brouwere, V.: The national free delivery and caesarean policy in Senegal: evaluating process and outcomes. Health Policy Plann. 25(5), 384–392 (2010). doi:10.​1093/​heapol/​czq013
36.
Ridde, V., Kouanda, S., Yameogo, M., Kadio, K., Bado, A.: Why do women pay more than they should? A mixed methods study of the implementation gap in a policy to subsidize the costs of deliveries in Burkina Faso. Eval. Progr. Plann. 36(1), 145–152 (2012)CrossRef
37.
Witter, S., Khalid Mousa, K., Abdel-Rahman, M., Hussein Al-Amin, R., Saed, M.: Removal of user fees for caesareans and under-fives in northern Sudan: a review of policy implementation and effectiveness. Int. J. Health Plan. Manag. (2012). doi:10.​1002/​hpm.​2146
38.
de Olivier Sardan, J.-P., Ridde, V.: Les contradictions des politiques publiques. Un bilan des mesures d’exemption de paiement des soins au Burkina Faso, au Mali et au Niger. Afr. Contemp. 243(3), 13–32 (2012)
39.
Ridde, V.: “The problem of the worst-off is dealt with after all other issues”: the equity and health policy implementation gap in Burkina Faso. Soc. Sci. Med. 66, 1368–1378 (2008)PubMedCrossRef
40.
Gilson, L., Kalyalya, D., Kuchler, F., Lake, S., Organa, H., Ouendo, M.: The equity impacts of community financing activities in three African countries. Int. J. Health Plann. Manag. 15, 291–317 (2000)CrossRef
41.
The Global Campaign for the Health Millennium Development Goals: leading by example—protecting the most vulnerable during the economic crisis, p. 59. Office of the Prime Minister of Norway, Oslo (2009)
42.
Victora, C., Barros, A., Axelson, H., Bhutta, Z., Chopra, M., França, G., Kerber, K., Kirkwood, B., Newby, H., Ronsmans, C., Boerma, J.: How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys. Lancet 380(9848), 1149–1156 (2012)PubMedCrossRef
43.
Ridde, V., Yaogo, M., Kafando, Y., Kadio, K., Ouedraogo, M., Bicaba, A., Haddad, A.: Targeting the worst-off for free health care: a process evaluation in Burkina Faso. Eval. Progr. Plann. 34(4), 333–342 (2011)CrossRef
44.
45.
Lagarde, M., Barroy, H., Palmer, N.: Assessing the effects of removing user fees in Zambia and Niger. J. Health Serv. Res. Policy 17(1), 30–36 (2012)PubMedCrossRef
46.
WHO: World Health Statistics 2013, p. 172. World Health Organization, Geneva (2013)
47.
Dzakpasu, S., Soremekun, S., Manu, A., ten Asbroek, G., Tawiah, C., Hurt, L., Fenty, J., Owusu-Agyei, S., Hill, Z., Campbell, O.M.R., Kirkwood, B.R.: Impact of free delivery care on health facility delivery and insurance coverage in Ghana’s Brong Ahafo region. PLoS One 7(11), e49430 (2012). doi:10.​1371/​journal.​pone.​0049430 PubMedCentralPubMedCrossRef
48.
WHO: The world health report–Health systems financing: the path to universal coverage. World Health Organization, Geneva (2010)
49.
IRSS: Évaluation des besoins en soins obstétricaux et néonataux d’urgence, couplée à la cartographie de l’offre de soins en santé de la reproduction au Burkina Faso. Rapport provisoire, p. 346. Institut de recherche en sciences de la santé-CNRST, Ouagadougou (2010)
50.
Mathauer, I., Carrin, G.: The role of institutional design and organizational practice for health financing performance and universal coverage. Health Policy 99, 183–192 (2011)PubMedCrossRef
Metadaten
Titel
The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso
verfasst von
V. Ridde
I. Agier
A. Jahn
O. Mueller
J. Tiendrebéogo
M. Yé
M. De Allegri
Publikationsdatum
01.01.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
The European Journal of Health Economics / Ausgabe 1/2015
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-013-0553-5

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