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User Charges (user + charge)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Catastrophic payments for health care in Asia

HEALTH ECONOMICS, Issue 11 2007
Eddy van Doorslaer
Abstract Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low/middle-income countries, the better-off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments. Copyright © 2007 John Wiley & Sons, Ltd. [source]

The role of user charges and structural attributes of quality on the use of maternal health services in Morocco

INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2005
David R. Hotchkiss
Abstract Health care decision makers in settings with low levels of utilization of primary services are faced with the challenge of balancing the sometimes competing goals of increasing coverage and utilization of maternity services, particularly among the poor, with that of ensuring the financial viability of the health system. Morocco is a case in point where this policy dilemma is currently being played out. This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. A nested logit model is estimated, and the coefficient estimates are used to carry out policy simulations of the impact of changes in the levels of out-of-pocket fees and structural attributes of quality in order to help guide policy makers responsible for the design of pending social insurance programs. The results of the paper suggest that social insurance strategies that involve increases in out-of-pocket charges in the form of copayments could be implemented without untoward effects on appropriate use of maternity care for non-poor women, but would be contraindicated for poorer and rural households. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Revenue-driven in TB control,three cases in China

INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004
Shaokang Zhan
Abstract One quarter of all TB cases occur in China, which, during the past 20 years has moved from a planned economy to a socialist market economy. In the health sector, an important proportion of the financing originates from user payment. TB control is not an exception and different programmatic models are in place. This study examines, using a case study approach, three different TB programmes, one supposed to provide free service, one subsidized service and one with full cost recovery. The aim was to better understand the driving forces for programme performance in terms of case detection, case management and patient payments. The study found for all models that control and case management approaches were, to some extent, adapted to generate maximum income to the providers. The drive for income led to fewer cases detected, administration of unnecessary procedures and drugs, and a higher than necessary cost to the patients. The latter possibly leading to exclusion of poor people from the services. If user charges are to stay, TB control programmes need to be designed to take advantage of the financial incentives to improve performance. The referral system needs to be restructured, not to provide disincentives for good practices. Copyright © 2004 John Wiley & Sons, Ltd. [source]

OF POLITICS AND PURPOSE: POLITICAL SALIENCE AND GOAL AMBIGUITY OF US FEDERAL AGENCIES

PUBLIC ADMINISTRATION, Issue 3 2009
JUNG WOOK LEE
As scholars have observed, government agencies have ambiguous goals. Very few large sample empirical studies, however, have tested such assertions and analysed variations among organizations in the characteristics of their goals. Researchers have developed concepts of organizational goal ambiguity, including ,evaluative goal ambiguity', and ,priority goal ambiguity', and found that these goal ambiguity variables related meaningfully to financial publicness (the degree of government funding versus prices or user charges), regulatory responsibility, and other variables. This study analyses the influence of the external political environment (external political authorities and processes) on goal ambiguity in government agencies; many researchers have analysed external influences on government bureaucracies, but very few have examined the effects on the characteristics of the organizations, such as their goals. This analysis of 115 US federal agencies indicates that higher ,political salience' to Congress, the president, and the media, relates to higher levels of goal ambiguity. A newly developed analytical framework for the analysis includes components for external environmental influences, organizational characteristics, and managerial influences, with new variables that represent components of the framework. Higher levels of political salience relate to higher levels of both types of goal ambiguity; components of the framework, however, relate differently to evaluative goal ambiguity than to priority goal ambiguity. The results contribute evidence of the viability of the goal ambiguity variables and the political environment variables. The results also show the value of bringing together concepts from organization theory and political science to study the effects of political environments on characteristics of government agencies. [source]