Out-of-pocket payments in the context of a free maternal health care policy in Burkina Faso: a national cross-sectional survey

Springer Science and Business Media LLC - Tập 9 - Trang 1-14 - 2019
Ivlabèhiré Bertrand Meda1,2,3,4, Adama Baguiya1,4, Valéry Ridde5,3, Henri Gautier Ouédraogo1,4, Alexandre Dumont5, Seni Kouanda1,4
1Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Ouagadougou, Burkina Faso
2École de Santé Publique de l’Université de Montréal (ESPUM), Montréal, Canada
3Institut de recherche en santé publique de l’Université de Montréal (IRSPUM), Montréal, Canada
4Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
5IRD (French Institute For Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France

Tóm tắt

In April 2016, Burkina Faso introduced a free health care policy for women. Instead of reimbursing health facilities, as many sub-Saharan countries do, the government paid them prospectively for covered services to avoid reimbursement delays, which are cited as a reason for the persistence of out-of-pocket (OOP) payments. This study aimed to (i) estimate the direct expenditures of deliveries and covered obstetric care, (ii) determine the OOP payments, and (iii) identify the patient and health facility characteristics associated with OOP payments. A national cross-sectional study was conducted in September and October 2016 in 395 randomly selected health facilities. A structured questionnaire was administered to women (n = 593) who had delivered or received obstetric care on the day of the survey. The direct health expenditures included fees for consultations, prescriptions, paraclinical examinations, hospitalization and ambulance transport. A two-part model with robust variances was performed to identify the factors associated with OOP payments. A total of 587 women were included in the analysis. The median direct health expenses were US$5.38 [interquartile range (IQR):4.35–6.65], US$24.72 [IQR:16.57–46.09] and US$136.39 [IQR: 108.36–161.42] for normal delivery, dystocia and cesarean section, respectively. Nearly one-third (29.6%, n = 174) of the women reported having paid for their care. OOP payments ranged from US$0.08 to US$98.67, with a median of US$1.77 [IQR:0.83–7.08]). Overall, 17.5% (n = 103) of the women had purchased drugs at private pharmacies, and 11.4% (n = 67) had purchased cleaning products for a room or equipment. OOP payments were more frequent with age, for emergency obstetric care and among women who work. The women’s health region of origin was also significantly associated with OOP payments. For those who made OOP payments, the amounts paid decreased with age but were higher in urban areas, in hospitals, and among the most educated women. The amounts paid were lower among students and were associated with health region. The policy is effective for financial protection. However, improvements in the management and supply system of health facilities’ pharmacies could further reduce OOP payments in the context of the free health care policy in Burkina Faso.

Tài liệu tham khảo

Robert E, Ridde V. Global health actors no longer in favor of user fees: a documentary study. Glob Health. 2013;9:29.

John EU. The impacts of user fees on health services in sub-Saharan African countries: a ctirical analysis of the evidence. Am J Public Health Res. 2013;1:196–202.

Richard F, Witter S, de Brouwere V. Innovative approaches to reducing financial barriers to obstetric care in low-income countries. Am J Public Health. 2010;100:1845–52.

Richard F, Antony M, Witter S, Kelley A, Sieleunou I, Kafando Y, et al. Fee exemption for maternal care in sub-Saharan Africa: a review of 11 countries and lessons for the region. Glob Health Gov. 2013;6:1–21.

Ridde V, Queuille L, Kafando Y, Robert É. Transversal analysis of public policies on user fees exemptions in six west African countries. BMC Health Serv Res. 2012;12:409.

Ridde V, Morestin F. A scoping review of the literature on the abolition of user fees in health care services in Africa. Health Policy Plan. 2011;26:1–11.

Witter S, Boukhalfa C, Cresswell JA, Daou Z, Filippi V, Ganaba R, et al. Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco. Int J Equity Health. 2016;15:123.

Asante F, Chikwama C, Daniels A, Armar-Klemesu M. Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in Ghana. Ghana Med J. 2007;41:110–7.

Chuma J, Musimbi J, Okungu V, Goodman C, Molyneux C. Reducing user fees for primary health care in Kenya: policy on paper or policy in practice? Int J Equity Health. 2009;8:15.

Dalinjong PA, Wang AY, Homer CSE. The operations of the free maternal care policy and out of pocket payments during childbirth in rural northern Ghana. Health Econ Rev. 2017;7:41.

Dalinjong PA, Wang AY, Homer CSE. Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in northern Ghana. PLoS One. 2018;13:e0184830.

Kruk ME, Mbaruku G, Rockers PC, Galea S. User fee exemptions are not enough: out-of-pocket payments for 'free' delivery services in rural Tanzania. Tropical Med Int Health. 2008;13:1442–51.

Opwora A, Waweru E, Toda M, Noor A, Edwards T, Fegan G, et al. Implementation of patient charges at primary care facilities in Kenya: implications of low adherence to user fee policy for users and facility revenue. Health Policy Plan. 2015;30:508–17.

Perkins M, Brazier E, Themmen E, Bassane B, Diallo D, Mutunga A, et al. Out-of-pocket costs for facility-based maternity care in three African countries. Health Policy Plan. 2009;24:289–300.

Ridde V, Kouanda S, Yameogo M, Kadio K, Bado A. Why do women pay more than they should? A mixed methods study of the implementation gap in a policy to subsidize the costs of deliveries in Burkina Faso. Eval Program Plann. 2013;36:145–52.

Wang Q, Fu AZ, Brenner S, Kalmus O, Banda HT, De Allegri M. Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi. PLoS One. 2015;10:e0116897.

Ridde V, Richard F, Bicaba A, Queuille L, Conombo G. The national subsidy for deliveries and emergency obstetric care in Burkina Faso. Health Policy Plan. 2011;26(Suppl 2):30–40.

Ministère de la Santé. Annuaire statistique 2016. In: Ouagadougou; 2017. http://www.sante.gov.bf/index.php?option=com_edocman&task=document.viewdoc&id=363&Itemid=1123. Accessed 15 Jun 2018.

Gorstein J, Sullivan KM, Parvanta I, Begin F. Indicators and methods for cross-sectional surveys of vitamin and mineral status of populations. Ottawa: Atlanta: the micronutrient initiative, centers for disease control and Prevention; 2007.

Tabachnick BG, Fidell LS. Using multivariate statistics. 6th ed. Boston, MA: Pearson Education; 2013.

Deb P, Norton EC. Health econometrics using stata. In: College Station. 1st ed. Texas: Stata Press; 2013.

Hilbe JM. Negative binomial regression. 2nd ed. Cambridge, UK: Cambridge University Press; 2011.

Hardin JW, Hilbe JM. Generalized linear models and extensions. In: College Station. 4th ed. Texas: Stata Press; 2018.

Kalu-Umeh NN, Sambo MN, Idris HS, Kurfi AM. Costs and patterns of financing maternal health care services in rural communities in northern Nigeria: evidence for designing national fee exemption policy. Int J MCH AIDS. 2013;2:163–72.

Opwora A, Kabare M, Molyneux S, Goodman C. Direct facility funding as a response to user fee reduction: implementation and perceived impact among Kenyan health centres and dispensaries. Health Policy Plan. 2010;25:406–18.

Witter S, Arhinfu DK, Kusi A, Zakariah-Akoto S. The experience of Ghana in implementing a user fee exemption policy to provide free delivery care. Reprod Health Matters. 2007;15:61–71.

Ousseini A, Kafando Y. La santé financière des dispositifs de soin face à la politique de gratuité. Les comités de gestion au Niger. Afr Contemp. 2012;243:65–76.

Pariyo GW, Ekirapa-Kiracho E, Okui O, Rahman MH, Peterson S, Bishai DM, et al. Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor? Int J Equity Health. 2009;8:39.

Ridde V, Robert E, Meessen B. A literature review of the disruptive effects of user fee exemption policies on health systems. BMC Public Health. 2012;12:289.

Institut National de la Statistique et de la Démographie (INSD). Enquête multisectorielle continue (EMC) 2014: Profil de pauvreté et d’inégalités. Ouagadougou: Institut National de la Statistique et de la Démographie (INSD); 2015.

Meda IB, Belemlilga YH, Millogo T, Kouanda S. Coûts médicaux des accouchements et des césariennes au Burkina Faso: une évaluation nationale. Science et Technique, Sciences de la Santé. 2018;41:31–9.

Dunne SS, Dunne CP. What do people really think of generic medicines? A systematic review and critical appraisal of literature on stakeholder perceptions of generic drugs. BMC Med. 2015;13:173.

Riner B, Bussy A, Hélène-Pelage J, Moueza N, Lamy S, Carrère P. “No generics, doctor!” the perspective of general practitioners in two French regions. BMC Health Serv Res. 2017;17:707.

Haddad S, Bicaba A, Feletto M, Taminy E, Kabore M, Ouedraogo B, et al. System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study. BMC Int Health Hum Rights. 2009;9 Suppl 1:S15.

Meda ZC, Konate L, Ouedraogo H, Sanou M, Hercot D, Sombie I. Leadership and vision in the improvement of universal health care coverage in low-income countries. Sante. 2011;21:178–84.

Mwase T, Brenner S, Mazalale J, Lohmann J, Hamadou S, Somda SMA, Ridde V, De Allegri M. Inequities and their determinants in coverage of maternal health services in Burkina Faso. Int J Equity Health. 2018;17:58.

Okolo CO, Reidpath DD, Allotey P. Socioeconomic inequalities in access to health care: examining the case of Burkina Faso. J Health Care Poor Underserved. 2011;22:663–82.

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Tập 9

1-14

Thông tin tác giả