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A literature review of the disruptive effects of user fee exemption policies on health systems
BACKGROUND: Several low- and middle-income countries have exempted patients from user fees in certain categories of population or of services. These exemptions are very effective in lifting part of the financial barrier to access to services, but they have been organized within unstable health syste...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370991/ https://www.ncbi.nlm.nih.gov/pubmed/22521207 http://dx.doi.org/10.1186/1471-2458-12-289 |
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author | Ridde, Valéry Robert, Emilie Meessen, Bruno |
author_facet | Ridde, Valéry Robert, Emilie Meessen, Bruno |
author_sort | Ridde, Valéry |
collection | PubMed |
description | BACKGROUND: Several low- and middle-income countries have exempted patients from user fees in certain categories of population or of services. These exemptions are very effective in lifting part of the financial barrier to access to services, but they have been organized within unstable health systems where there are sometimes numerous dysfunctions. The objective of this article is to bring to light the disruptions triggered by exemption policies in health systems of low- and middle-income countries. METHODS: Scoping review of 23 scientific articles. The data were synthesized according to the six essential functions of health systems. RESULTS: The disruptions included specifically: 1) immediate and significant increases in service utilization; 2) perceived heavier workloads for health workers, feelings of being exploited and overworked, and decline in morale; 3) lack of information about free services provided and their reimbursement; 4) unavailability of drugs and delays in the distribution of consumables; 5) unpredictable and insufficient funding, revenue losses for health centres, reimbursement delays; 6) the multiplicity of actors and the difficulty of identifying who is responsible (‘no blame’ game), and deficiencies in planning and communication. CONCLUSIONS: These disruptive elements give us an idea of what is to be expected if exemption policies do not put in place all the required conditions in terms of preparation, planning and complementary measures. There is a lack of knowledge on the effects of exemptions on all the functions of health systems because so few studies have been carried out from this perspective. |
format | Online Article Text |
id | pubmed-3370991 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-33709912012-06-09 A literature review of the disruptive effects of user fee exemption policies on health systems Ridde, Valéry Robert, Emilie Meessen, Bruno BMC Public Health Research Article BACKGROUND: Several low- and middle-income countries have exempted patients from user fees in certain categories of population or of services. These exemptions are very effective in lifting part of the financial barrier to access to services, but they have been organized within unstable health systems where there are sometimes numerous dysfunctions. The objective of this article is to bring to light the disruptions triggered by exemption policies in health systems of low- and middle-income countries. METHODS: Scoping review of 23 scientific articles. The data were synthesized according to the six essential functions of health systems. RESULTS: The disruptions included specifically: 1) immediate and significant increases in service utilization; 2) perceived heavier workloads for health workers, feelings of being exploited and overworked, and decline in morale; 3) lack of information about free services provided and their reimbursement; 4) unavailability of drugs and delays in the distribution of consumables; 5) unpredictable and insufficient funding, revenue losses for health centres, reimbursement delays; 6) the multiplicity of actors and the difficulty of identifying who is responsible (‘no blame’ game), and deficiencies in planning and communication. CONCLUSIONS: These disruptive elements give us an idea of what is to be expected if exemption policies do not put in place all the required conditions in terms of preparation, planning and complementary measures. There is a lack of knowledge on the effects of exemptions on all the functions of health systems because so few studies have been carried out from this perspective. BioMed Central 2012-06-08 /pmc/articles/PMC3370991/ /pubmed/22521207 http://dx.doi.org/10.1186/1471-2458-12-289 Text en Copyright ©2012 Ridde et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Ridde, Valéry Robert, Emilie Meessen, Bruno A literature review of the disruptive effects of user fee exemption policies on health systems |
title | A literature review of the disruptive effects of user fee exemption policies on health systems |
title_full | A literature review of the disruptive effects of user fee exemption policies on health systems |
title_fullStr | A literature review of the disruptive effects of user fee exemption policies on health systems |
title_full_unstemmed | A literature review of the disruptive effects of user fee exemption policies on health systems |
title_short | A literature review of the disruptive effects of user fee exemption policies on health systems |
title_sort | literature review of the disruptive effects of user fee exemption policies on health systems |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370991/ https://www.ncbi.nlm.nih.gov/pubmed/22521207 http://dx.doi.org/10.1186/1471-2458-12-289 |
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