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User Fees (user + fee)
Selected AbstractsUser Fees for Health Services: Guidelines for Protecting the Poor, by William Newbrander, David Collins and Lucy Gilson.HEALTH ECONOMICS, Issue 2 20022001., Boston, Management Sciences for Health No abstract is available for this article. [source] Quality improvement and its impact on the use and equality of outpatient health services in IndiaHEALTH ECONOMICS, Issue 8 2007Krishna Dipankar Rao Abstract This paper examines the impact of quality improvements in conjunction with user fees on the utilization and equality of outpatient services at a range of public sector health facilities in India. Project impact on outpatient visits was estimated via the difference-in-difference method using pooled time series visit data from project and control facilities. The results indicate that the quality improvements significantly increased visits at all facility types. The project effect was largest at primary health center (PHC) and community health center (CHC), followed by district hospital (DH) and female district hospital (FDH). Pro-rich inequalities in outpatient visits increased at DHs and FDHs while at CHCs and PHCs the distribution remained equitable. This suggests that quality improvements at public sector health facilities can increase utilization of outpatient services in the presence of nominal user fees, but can also promote greater inequality favoring the better-off. At the referral hospital level, quality improvements should be made in conjuction with programs which encourage utilization by the poor. In contrast, the benefit of quality improvements at PHCs and CHCs is equitably distributed. Copyright © 2006 John Wiley & Sons, Ltd. [source] Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in RwandaHEALTH ECONOMICS, Issue 1 2006Pia Schneider Abstract This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out-of-pocket health spending contributed to increased poverty. The analysis uses cross-sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community-based health insurance. Results indicate that health spending had a small impact on the socio-economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user-fee paying individuals who reported significantly lower visit rates than the insured. Copyright © 2005 John Wiley & Sons, Ltd. [source] District health systems in a neoliberal world: a review of five key policy areas,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2003Malcolm Segall Abstract District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a ,second generation' reform,to be superseded by third generation reforms with a market orientation,flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass compaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor. Copyright © 2003 John Wiley & Sons, Ltd. [source] A Contingency View of the Responses of Voluntary Social Service Organizations in Ontario to Government CutbacksCANADIAN JOURNAL OF ADMINISTRATIVE SCIENCES, Issue 1 2002Mary K. Foster Voluntary organizations in Ontario have been thrust into a new environment; government funding on which they have traditionally counted has been reduced to the extent that actions have to be taken in order for some organizations to survive. Using a sample of 85 from a mailed survey to voluntary social service organizations in Toronto, we collected information on how organizational characteristics are influencing the actions taken in the face of these changes. We found that the alternatives considered factored into five dimensions: enhancing the image of the organization; cutting costs; developing strategic plans and accountability; implementing new tactics, such as user fees; and restructuring the governance and management structure. Analysis showed that younger organizations, smaller-sized agencies, and those with a diverse set of funding sources employ a wider range of options to deal with environmental challenges. Many of these options are directed at protecting the main mission of the organization and building awareness and marketing strength so that the organization reduces its susceptibility to environmental shifts. Résumé Les organismes de bénévolat de l'Ontario sont plongés dans un nouveau contexte, car les subventions gouvernementales sur lesquelles ils comptaient jusqu'à présent sont réduites à un point tel que des mesures doivent être prises afin qu'ils puissent survivre. Un sondage effectué par la poste auprès de 85 organismes de services sociaux bénévoles de Toronto nous a permis de rassembler des données montrant que certaines caractéristiques organisationnelles peuvent influencer les mesures à prendre face à de tels changements, et nous avons envisagé cinq solutions possibles pour remédier à la situation: rehausser l'image de ces organismes; réduire leurs coûts; mettre sur pied certaines stratégies et rendre compte de leurs activités; utiliser de nouvelles tactiques, tels des frais d'utilisation; ainsi qu'en restructurer l'administration et la gestion. Il ressort de cette analyse que les organismes plus récents et de plus petite taille ainsi que ceux bénéficiant de sources de financement plus variées peuvent utiliser un plus vaste ventail d'options pour contrer les difficultés que présente la conjoncture actuelle. La plupart de ces possibilités visent à préserver la mission principale de ces organismes et à renforcer leur vision et leur politique de marketing afin de réduire leur vulnérabilité face à tout changement conjoncturel. [source] | ||||||||||