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User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica

BACKGROUND: The impact of user–fee policies on the equity of health care utilization and households’ financial burdens has remained largely unexplored in Latin American and the Caribbean, as well as in upper–middle–income countries. This paper assesses the short– and long–term impacts of Jamaica’s u...

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Autores principales: Li, Zhihui, Li, Mingqiang, Fink, Günther, Bourne, Paul, Bärnighausen, Till, Atun, Rifat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Edinburgh University Global Health Society 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481893/
https://www.ncbi.nlm.nih.gov/pubmed/28685038
http://dx.doi.org/10.7189/jogh.07.010502
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author Li, Zhihui
Li, Mingqiang
Fink, Günther
Bourne, Paul
Bärnighausen, Till
Atun, Rifat
author_facet Li, Zhihui
Li, Mingqiang
Fink, Günther
Bourne, Paul
Bärnighausen, Till
Atun, Rifat
author_sort Li, Zhihui
collection PubMed
description BACKGROUND: The impact of user–fee policies on the equity of health care utilization and households’ financial burdens has remained largely unexplored in Latin American and the Caribbean, as well as in upper–middle–income countries. This paper assesses the short– and long–term impacts of Jamaica’s user–fee–removal for children in 2007. METHODS: This study utilizes 14 rounds of data from the Jamaica Survey of Living Conditions (JSLC) for the periods 1996 to 2012. JSLC is a national household survey, which collects data on health care utilization and among other purposes for planning. Interrupted time series (ITS) analysis was used to examine the immediate impact of the user–fee–removal policy on children’s health care utilization and households’ financial burdens, as well as the impact in the medium– to long–term. RESULTS: Immediately following the implementation of user–fee–removal, the odds of seeking for health care if the children fell ill in the past 4 weeks increased by 97% (odds ratio 2.0, 95% confidence interval (CI) 1.1 to 3.5, P = 0.018). In the short–term (2007–2008), health care utilization increased at a faster rate among children not in poverty than children in poverty; while this gap narrowed after 2008. There was minimal difference in health care utilization across wealth groups in the medium– to long–term. The household’s financial burden (health expenditure as a share of household’s non–food expenditures) reduced by 6 percentage points (95% CI: –11 to –1, P = 0.020) right after the policy was implemented and kept at a low level. The difference in financial burden between children in poverty and children not in poverty shrunk rapidly after 2007 and remained small in subsequent years. CONCLUSIONS: User–fee–removal had a positive impact on promoting health care utilization among children and reducing their household health expenditures in Jamaica. The short–term and the medium– to long–term results have different indications: In the short–term, the policy deteriorated the equity of access to health care for children, while the equity status improved fast in the medium– to long–term.
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spelling pubmed-54818932017-07-06 User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica Li, Zhihui Li, Mingqiang Fink, Günther Bourne, Paul Bärnighausen, Till Atun, Rifat J Glob Health Research Theme 1: Health Policy and Systems Research BACKGROUND: The impact of user–fee policies on the equity of health care utilization and households’ financial burdens has remained largely unexplored in Latin American and the Caribbean, as well as in upper–middle–income countries. This paper assesses the short– and long–term impacts of Jamaica’s user–fee–removal for children in 2007. METHODS: This study utilizes 14 rounds of data from the Jamaica Survey of Living Conditions (JSLC) for the periods 1996 to 2012. JSLC is a national household survey, which collects data on health care utilization and among other purposes for planning. Interrupted time series (ITS) analysis was used to examine the immediate impact of the user–fee–removal policy on children’s health care utilization and households’ financial burdens, as well as the impact in the medium– to long–term. RESULTS: Immediately following the implementation of user–fee–removal, the odds of seeking for health care if the children fell ill in the past 4 weeks increased by 97% (odds ratio 2.0, 95% confidence interval (CI) 1.1 to 3.5, P = 0.018). In the short–term (2007–2008), health care utilization increased at a faster rate among children not in poverty than children in poverty; while this gap narrowed after 2008. There was minimal difference in health care utilization across wealth groups in the medium– to long–term. The household’s financial burden (health expenditure as a share of household’s non–food expenditures) reduced by 6 percentage points (95% CI: –11 to –1, P = 0.020) right after the policy was implemented and kept at a low level. The difference in financial burden between children in poverty and children not in poverty shrunk rapidly after 2007 and remained small in subsequent years. CONCLUSIONS: User–fee–removal had a positive impact on promoting health care utilization among children and reducing their household health expenditures in Jamaica. The short–term and the medium– to long–term results have different indications: In the short–term, the policy deteriorated the equity of access to health care for children, while the equity status improved fast in the medium– to long–term. Edinburgh University Global Health Society 2017-06 2017-06-19 /pmc/articles/PMC5481893/ /pubmed/28685038 http://dx.doi.org/10.7189/jogh.07.010502 Text en Copyright © 2017 by the Journal of Global Health. All rights reserved. http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License.
spellingShingle Research Theme 1: Health Policy and Systems Research
Li, Zhihui
Li, Mingqiang
Fink, Günther
Bourne, Paul
Bärnighausen, Till
Atun, Rifat
User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica
title User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica
title_full User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica
title_fullStr User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica
title_full_unstemmed User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica
title_short User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica
title_sort user–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from jamaica
topic Research Theme 1: Health Policy and Systems Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481893/
https://www.ncbi.nlm.nih.gov/pubmed/28685038
http://dx.doi.org/10.7189/jogh.07.010502
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