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.
Burkina Faso
Health Financing
Out-of-Pocket Expenditures
Performance-Based Financing
Universal Health Coverage
User Fee Removal
Journal
International journal of health policy and management
ISSN: 2322-5939
Titre abrégé: Int J Health Policy Manag
Pays: Iran
ID NLM: 101619905
Informations de publication
Date de publication:
2023
2023
Historique:
received:
09
09
2021
accepted:
22
11
2022
medline:
16
8
2023
pubmed:
14
8
2023
entrez:
14
8
2023
Statut:
ppublish
Résumé
Burkina Faso has been implementing financing reforms towards universal health coverage (UHC) since 2006. Recently, the country introduced a performance-based financing (PBF) program as well as user fee removal (gratuité) policy for health services aimed at pregnant and lactating women and children under 5. We aim to assess the effect of 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 5 and individuals above 5 to assess the effect of the The proportion of children under 5 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 difference in differences estimates indicated that gratuité 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. 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.
Sections du résumé
BACKGROUND
Burkina Faso has been implementing financing reforms towards universal health coverage (UHC) since 2006. Recently, the country introduced a performance-based financing (PBF) program as well as user fee removal (gratuité) policy for health services aimed at pregnant and lactating women and children under 5. We aim to assess the effect of
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 5 and individuals above 5 to assess the effect of the
RESULTS
The proportion of children under 5 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 difference in differences estimates indicated that gratuité 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.
CONCLUSION
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.
Identifiants
pubmed: 37579448
doi: 10.34172/ijhpm.2022.6767
pii: 6767
pmc: PMC10125104
doi:
pii:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
6767Informations de copyright
© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Références
Matern Child Health J. 2019 Jun;23(6):777-786
pubmed: 30580393
World Dev. 2018 Jan;101:334-350
pubmed: 29422705
Health Policy Plan. 2018 Oct 1;33(8):948-956
pubmed: 30256941
Eval Program Plann. 2013 Feb;36(1):145-52
pubmed: 23123308
Trop Med Int Health. 2008 Dec;13(12):1442-51
pubmed: 18983268
BMJ Open. 2016 Jan 28;6(1):e009692
pubmed: 26823178
Health Policy Plan. 2011 Nov;26 Suppl 2:ii41-51
pubmed: 22027918
Appl Health Econ Health Policy. 2006;5(3):137-53
pubmed: 17132029
J Epidemiol Community Health. 2010 Jan;64(1):10-5
pubmed: 19692724
Health Econ Rev. 2020 May 27;10(1):14
pubmed: 32462272
Bull World Health Organ. 2006 Jan;84(1):21-7
pubmed: 16501711
Int J Health Policy Manag. 2022 Mar 01;11(3):308-322
pubmed: 32729286
Cochrane Database Syst Rev. 2011 Apr 13;(4):CD009094
pubmed: 21491414
PLoS One. 2015 Oct 26;10(10):e0141306
pubmed: 26501561
Soc Sci Med. 2010 Nov;71(10):1749-56
pubmed: 20541307
BMJ Open. 2019 Feb 20;9(2):e022414
pubmed: 30787074
BMC Health Serv Res. 2015 Aug 08;15:313
pubmed: 26253339
Soc Sci Med. 2008 Feb;66(3):545-57
pubmed: 18061325
PLoS One. 2016 Jan 21;11(1):e0146508
pubmed: 26795620
BMC Health Serv Res. 2021 Feb 6;21(1):125
pubmed: 33549089
BMC Health Serv Res. 2014 Mar 11;14:120
pubmed: 24612450
PLoS One. 2017 Oct 31;12(10):e0187293
pubmed: 29088302
BMJ Glob Health. 2019 Nov 24;4(6):e001809
pubmed: 31803510
PLoS One. 2018 Feb 1;13(2):e0184830
pubmed: 29389995
Soc Sci Med. 2017 Apr;179:27-35
pubmed: 28242542
J Health Serv Res Policy. 2004 Oct;9(4):197-204
pubmed: 15509405
Implement Sci. 2007 Nov 30;2:40
pubmed: 18053122
Soc Sci Med. 2017 Jul;185:46-53
pubmed: 28554158
Health Policy Plan. 2020 Oct 1;35(8):906-917
pubmed: 32601671
SSM Popul Health. 2017 Jan 10;3:179-184
pubmed: 29349214
Public Health Nutr. 2021 Aug;24(12):3768-3779
pubmed: 33593454
BMC Health Serv Res. 2019 Oct 22;19(1):733
pubmed: 31640694
Int J Equity Health. 2018 Sep 24;17(1):109
pubmed: 30244685
Health Econ Rev. 2019 Mar 27;9(1):11
pubmed: 30919219
Bull World Health Organ. 2017 Jul 1;95(7):537-539
pubmed: 28670019
PLoS Negl Trop Dis. 2019 Feb 28;13(2):e0007164
pubmed: 30817776
Health Policy Plan. 2015 Dec;30(10):1251-60
pubmed: 25533992
Trop Med Int Health. 2020 Oct;25(10):1226-1234
pubmed: 32686252
Health Econ Rev. 2015 May 27;5:11
pubmed: 26029491
Health Econ Rev. 2020 Nov 14;10(1):36
pubmed: 33188618
Cochrane Database Syst Rev. 2021 May 5;5:CD007899
pubmed: 33951190
PLoS One. 2017 Sep 21;12(9):e0182326
pubmed: 28934320
Malar J. 2018 Oct 22;17(1):380
pubmed: 30348157
Ghana Med J. 2007 Sep;41(3):110-7
pubmed: 18470328
Int J Equity Health. 2018 Jan 08;17(1):5
pubmed: 29310690
Int J Environ Res Public Health. 2020 Jan 08;17(2):
pubmed: 31936308
Eur J Health Econ. 2015 Jan;16(1):55-64
pubmed: 24414280
Annu Rev Public Health. 2018 Apr 1;39:489-505
pubmed: 29328879
Trop Med Int Health. 2021 Aug;26(8):1002-1013
pubmed: 33910267
PLoS One. 2021 Feb 8;16(2):e0244395
pubmed: 33556057
Health Policy Plan. 2015 May;30(4):508-17
pubmed: 24837638
BMC Health Serv Res. 2015;15 Suppl 3:S6
pubmed: 26559564
BMC Health Serv Res. 2012 Nov 21;12:412
pubmed: 23171417
Int J Health Policy Manag. 2022 May 01;11(5):670-682
pubmed: 33201654
Int J Environ Res Public Health. 2020 Sep 08;17(18):
pubmed: 32911868