Limits...
Improving equity by removing healthcare fees for children in Burkina Faso.

Ridde V, Haddad S, Heinmüller R - J Epidemiol Community Health (2013)

Bottom Line: The exemption benefited the children of poor families when health need was high and services near (RR=5.23; (1.30 to 20.99)).Exempting children under five from user fees is effective and helps reduce inequities of access.It benefits vulnerable populations, although their service utilisation remains constrained by limitations in geographic accessibility of services.

View Article: PubMed Central - PubMed

Affiliation: University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada. valery.ridde@umontreal.ca

ABSTRACT

Background: This study evaluated the effects on healthcare access inequities of an intervention exempting children under 5 years from user fees in Burkina Faso.

Methods: The design consisted of two complementary studies. The first was an interrupted time series (56 months before and 12 months after) study of daily curative consultations according to distance (<5, 5-9 and ≥10 km) in a stratified random sample of 18 health centres: 12 with the intervention and 6 without. The second was a household panel survey (n=1214) assessing the evolution of health-seeking behaviours. Multilevel regression was used throughout.

Results: Attendance doubled under the intervention, after adjusting for Centres de Santé et de Promotion Sociale size, districts, secular trend and seasonal variation. Utilisation increased for all distance ranges and in all of the 12 health centres of the intervention area. The exemption benefited all children (rate ratios (RR)=1.52 (1.23 to 1.88)), whether their health needs were high (RR=1.69 (1.22 to 2.32)) or not (RR=1.46 (1.10 to 1.93)) and whether the children lived near (RR=1.42 (1.09 to 1.85)) or far from a health centre (RR=1.79 (1.31 to 2.43)). The exemption benefited the children of poor families when health need was high and services near (RR=5.23; (1.30 to 20.99)). The amount saved for a child's treatment by the exemption was on average and median 2500 F CFA (≈US$5).

Conclusions: Exempting children under five from user fees is effective and helps reduce inequities of access. It benefits vulnerable populations, although their service utilisation remains constrained by limitations in geographic accessibility of services.

Show MeSH

Related in: MedlinePlus

Health expenditure distributions according to place of residence
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3756435&req=5

JECH2012202080F4: Health expenditure distributions according to place of residence

Mentions: The exemption reduced the expenses incurred for children's treatment at the CSPS (table 5). The amount saved for a child's treatment was on average 2500 F CFA, or around US$5 (same value for the median benefit). This is a substantial benefit when considered in light of rural households' meagre capacity to pay in that country (where 46% live on less than 275 F CFA/day18); the majority of these householders are farmers or herdsmen for whom, in the rainy season, it is extremely difficult to raise cash on short notice to cover their families' needs. All the groups we considered benefited from the exemption (table 5). The distribution of expenses narrowed considerably, and 85% of the care episodes were entirely free of charge. Figures 2–4 present the Kernel density estimates of the probability density function. Horizontal disparities (inequalities within each group) were demonstrably substantially reduced after the intervention. In 2008, health expenditure distributions were comparable between poor and non-poor children, whether their episodes of illness were severe or not, and regardless of whether they lived near or far from a health centre. These distributions narrowed considerably in 2009. They evolved comparably in terms of severity of illness episode (figure 2); the changes were also comparable for poor and non-poor children (figure 3). Figure 4 shows that the reduction of more than 90% in children's health expenditures actually reflects considerable narrowing in the distribution of their expenditures. The form of the 2009 distributions confirms that these children were the primary beneficiaries of removing user fees. The narrowing is less marked, but still significant, in children for whom medical expenditures at health centres represented only a fraction of their total expenditure, and thus particularly children living more than 5 km from a centre.


Improving equity by removing healthcare fees for children in Burkina Faso.

Ridde V, Haddad S, Heinmüller R - J Epidemiol Community Health (2013)

Health expenditure distributions according to place of residence
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756435&req=5

JECH2012202080F4: Health expenditure distributions according to place of residence
Mentions: The exemption reduced the expenses incurred for children's treatment at the CSPS (table 5). The amount saved for a child's treatment was on average 2500 F CFA, or around US$5 (same value for the median benefit). This is a substantial benefit when considered in light of rural households' meagre capacity to pay in that country (where 46% live on less than 275 F CFA/day18); the majority of these householders are farmers or herdsmen for whom, in the rainy season, it is extremely difficult to raise cash on short notice to cover their families' needs. All the groups we considered benefited from the exemption (table 5). The distribution of expenses narrowed considerably, and 85% of the care episodes were entirely free of charge. Figures 2–4 present the Kernel density estimates of the probability density function. Horizontal disparities (inequalities within each group) were demonstrably substantially reduced after the intervention. In 2008, health expenditure distributions were comparable between poor and non-poor children, whether their episodes of illness were severe or not, and regardless of whether they lived near or far from a health centre. These distributions narrowed considerably in 2009. They evolved comparably in terms of severity of illness episode (figure 2); the changes were also comparable for poor and non-poor children (figure 3). Figure 4 shows that the reduction of more than 90% in children's health expenditures actually reflects considerable narrowing in the distribution of their expenditures. The form of the 2009 distributions confirms that these children were the primary beneficiaries of removing user fees. The narrowing is less marked, but still significant, in children for whom medical expenditures at health centres represented only a fraction of their total expenditure, and thus particularly children living more than 5 km from a centre.

Bottom Line: The exemption benefited the children of poor families when health need was high and services near (RR=5.23; (1.30 to 20.99)).Exempting children under five from user fees is effective and helps reduce inequities of access.It benefits vulnerable populations, although their service utilisation remains constrained by limitations in geographic accessibility of services.

View Article: PubMed Central - PubMed

Affiliation: University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada. valery.ridde@umontreal.ca

ABSTRACT

Background: This study evaluated the effects on healthcare access inequities of an intervention exempting children under 5 years from user fees in Burkina Faso.

Methods: The design consisted of two complementary studies. The first was an interrupted time series (56 months before and 12 months after) study of daily curative consultations according to distance (<5, 5-9 and ≥10 km) in a stratified random sample of 18 health centres: 12 with the intervention and 6 without. The second was a household panel survey (n=1214) assessing the evolution of health-seeking behaviours. Multilevel regression was used throughout.

Results: Attendance doubled under the intervention, after adjusting for Centres de Santé et de Promotion Sociale size, districts, secular trend and seasonal variation. Utilisation increased for all distance ranges and in all of the 12 health centres of the intervention area. The exemption benefited all children (rate ratios (RR)=1.52 (1.23 to 1.88)), whether their health needs were high (RR=1.69 (1.22 to 2.32)) or not (RR=1.46 (1.10 to 1.93)) and whether the children lived near (RR=1.42 (1.09 to 1.85)) or far from a health centre (RR=1.79 (1.31 to 2.43)). The exemption benefited the children of poor families when health need was high and services near (RR=5.23; (1.30 to 20.99)). The amount saved for a child's treatment by the exemption was on average and median 2500 F CFA (≈US$5).

Conclusions: Exempting children under five from user fees is effective and helps reduce inequities of access. It benefits vulnerable populations, although their service utilisation remains constrained by limitations in geographic accessibility of services.

Show MeSH
Related in: MedlinePlus