2023-09-28 14:46:10 +00:00
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abstract: 'Background: Since the advent of health user fees in low- and
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middle-income countries in the 1980s, the discourse of global health
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actors (GHAs) has changed to the disadvantage of this type of healthcare
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financing mechanism. The aim of the study was to identify and analyze
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the stance of GHAs in the debate on user fees.
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Methods: We conducted documentary research using public documents
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published by and officially attributed to GHAs from 2005 to 2011. We
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categorized GHAs into four groups: intergovernmental organizations,
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international non-governmental organizations, government agencies, and
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working groups and networks. We then classified the GHAs according to
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their stance relative to the abolition of user fees, and conducted a
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thematic analysis of their discourse to understand the arguments used by
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each GHA to justify its stance.
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Results: We identified 56 GHAs, for which we analyzed 140 documents.
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Among them, 55\% were in favor of the abolition of user fees or in favor
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of free care at the point of delivery. None of the GHAs stated that they
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were in favor of user fees; however, 30\% did not take a stand. Only the
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World Bank declares that it is both in favor of user fees and in favor
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of free care at point of service. GHAs generally circumscribe their
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stance to specific populations (pregnant women, children under 5 years,
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etc.) or to specific health services (primary, basic, essential). Three
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types of arguments are used by GHAs to justify their stance: economic,
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moral and ethical, and pragmatic.
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Conclusions: The principle of ``user pays{''''} seems to have fizzled.
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Production and dissemination of evidence, as well as certain advocacy
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networks, may have contributed to this change in discourse. However,
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GHAs should go a step further and translate their words into action, so
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that free healthcare at the point of delivery becomes a reality in low-
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and middle-income countries. They should provide technical and financial
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support to those countries that have chosen to implement user fee
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exemption policies, sometimes influenced by a GHA.'
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affiliation: 'Robert, E (Corresponding Author), Univ Montreal, Fac Med, CRCHUM, Pavillon
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Masson,3850,Rue St Urbain, Montreal, PQ H2W 1T7C, Canada.
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Robert, Emilie; Ridde, Valery, Univ Montreal, Fac Med, CRCHUM, Montreal, PQ H2W
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1T7C, Canada.
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Ridde, Valery, Univ Montreal, Dept Med Social \& Prevent, Montreal, PQ H2W 1T7C,
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Canada.'
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article-number: '29'
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author: Robert, Emilie and Ridde, Valery
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author-email: emilie.robert.3@umontreal.ca
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author_list:
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- family: Robert
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given: Emilie
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- family: Ridde
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given: Valery
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da: '2023-09-28'
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doi: 10.1186/1744-8603-9-29
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eissn: 1744-8603
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files: []
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journal: GLOBALIZATION AND HEALTH
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keywords: 'User fees; LMICs; International health policy; Global health actors;
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Policy change'
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keywords-plus: 'LOW-INCOME COUNTRIES; STAKEHOLDER ANALYSIS; PUBLIC-HEALTH; POLICY;
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CARE;
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COVERAGE; LESSONS; REFORMS; AFRICA; NEED'
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language: English
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month: JUL 26
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number-of-cited-references: '111'
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orcid-numbers: 'Ridde, Valery/0000-0001-9299-8266
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Robert, Emilie/0000-0002-2260-1873'
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papis_id: 6221ddb94e462dd475bda1a9c1633311
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ref: Robert2013globalhealth
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researcherid-numbers: 'ridde, valery/AAV-1016-2020
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Ridde, Valery/AAD-2736-2019
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'
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times-cited: '32'
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title: 'Global health actors no longer in favor of user fees: a documentary 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:000323004200001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '7'
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volume: '9'
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web-of-science-categories: Public, Environmental \& Occupational Health
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year: '2013'
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