2023-09-28 14:46:10 +00:00
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abstract: 'Background: User fees have been shown to constitute a major barrier to
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the utilisation of health-care, particularly in low-income countries
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such as the Democratic Republic of Congo (DRC). Importantly, such
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barriers can lead to the exclusion of vulnerable individuals from
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health-care. In 2008, a donor-funded primary health-care programme began
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implementing user fee subsidisation in 20 health zones of the DRC. In
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this study, we quantified the short and long-term effects of this policy
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on health-care utilisation.
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Methods: Sixteen health zones were included for analysis. Using
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routinely collected health-care utilisation data before and after policy
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implementation, interrupted time series regression was applied to
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quantify the temporal impact of the user fee policy in the studied
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health zones. Payment of salary supplements to health-care workers and
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provision of free drugs - the other components of the programme - were
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controlled for where possible.
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Results: Fourteen (88\%) health zones showed an immediate positive
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effect in health-care utilisation rates (overall median increase of
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19\%, interquartile range 11 to 43) one month after the policy was
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introduced, and the effect was significant in seven zones (P <0.05).
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This initial effect was sustained or increased at 24 months in five
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health zones but was only significant in one health zone at P <0.05.
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Utilisation reduced over time in the remaining health zones (overall
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median increase of 4\%, interquartile range -10 to 33). The modelled
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mean health-care utilisation rate initially increased significantly from
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43 consultations/1000 population to 51 consultations/1000 population
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during the first month following implementation (P <0.01). However, the
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on-going effect was not significant (P =0.69).
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Conclusions: Our research brings mixed findings on the effectiveness of
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user fee subsidisation as a strategy to increase the utilisation of
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services. Future work should focus on feasibility issues associated with
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the removal or reduction of user fees and how to sustain its effects on
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utilisation in the longer term.'
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affiliation: 'Maini, R (Corresponding Author), Dept Int Dev, 83 Ave Roi Baudouin,
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Kinshasa, DEM REP CONGO.
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Maini, Rishma; Carter, Daniel, Dept Int Dev, 83 Ave Roi Baudouin, Kinshasa, DEM
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REP CONGO.
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Van den Bergh, Rafael; Tayler-Smith, Katie; Zachariah, Rony, Med Sans Frontieres
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Operat Ctr Brussels, Operat Res Unit LuxOR, Luxembourg, Luxembourg.
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van Griensven, Johan, Inst Trop Med, B-2000 Antwerp, Belgium.
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Ousley, Janet; Ho, Lara, Int Rescue Comm, Kinshasa, DEM REP CONGO.
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Mhatre, Seb, Dept Int Dev, London, England.'
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article-number: '504'
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author: Maini, Rishma and Van den Bergh, Rafael and van Griensven, Johan and Tayler-Smith,
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Katie and Ousley, Janet and Carter, Daniel and Mhatre, Seb and Ho, Lara and Zachariah,
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Rony
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author-email: mainirishma@gmail.com
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author_list:
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- family: Maini
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given: Rishma
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- family: Van den Bergh
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given: Rafael
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- family: van Griensven
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given: Johan
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- family: Tayler-Smith
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given: Katie
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- family: Ousley
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given: Janet
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- family: Carter
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given: Daniel
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- family: Mhatre
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given: Seb
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- family: Ho
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given: Lara
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- family: Zachariah
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given: Rony
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da: '2023-09-28'
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doi: 10.1186/s12913-014-0504-6
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files: []
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issn: 1472-6963
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journal: BMC HEALTH SERVICES RESEARCH
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keywords: 'User fees; Subsidisation; Health-care utilisation; Operational research;
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DRC'
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keywords-plus: FINANCIAL BARRIERS; SERVICES
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language: English
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month: NOV 5
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number-of-cited-references: '23'
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orcid-numbers: 'Van den Bergh, Rafael/0000-0001-6277-8713
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Maini, Rishma/0000-0002-0835-6154
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zachariah, rony/0000-0002-2915-9328'
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papis_id: a0de866a34a65e72534a6b1e4c26b3a2
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ref: Maini2014pickingbill
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times-cited: '12'
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title: 'Picking up the bill - improving health-care utilisation in the Democratic
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Republic of Congo through user fee subsidisation: a before and after study'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000348416100001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '0'
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volume: '14'
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web-of-science-categories: Health Care Sciences \& Services
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year: '2014'
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