Renaud Boulanger, Matthew Hunt and Valéry Ridde – Towards a health ethics policy framework to analyse user fee exemptions – 12th World Congress of Bioethics – June 25-28 2014, Mexico.
Poster presented at the fith Annual Global Health Conference, Washington, 11-05-2014.
Poster presented by Anthony Lacouture, at the ” KT Canada Summer Institute on Knowledge Translation : Knowledge Translation for 4 Ps (patients, providers, public and policymakers), which took place from 9th to 11th of june in Québéc, Canada. (more…)
New article published in Journal of Health Services Research & Policy
Queuille, L., & Ridde, V. (2013). User fees exemption: one step on the path toward universal access to healthcare. Pilot experience in Burkina Faso (DVD).
In 2008, the regional health department (RHD) of the Sahel region in Burkina Faso and the German NGO HELP, funded by the European Community Humanitarian Office (ECHO), decided to experiment with user fee exemptions for children under five years of age and pregnant and nursing women. The objectives of this initiative were to provide healthcare services to vulnerable populations and to improve the national health policy. The project established a scientific partnership with the University of Montreal (CRCHUM). This DVD presents the results of studies carried out between 2008 and 2013, including nearly 70 scientific articles, a book, book chapters, policy briefs, publications for the general public, and documentary films in French and /or English.
To obtain a copy of the DVD, please contact us.
Visit the project page for more information.
Ridde, V., Agier, I., Jahn, A., Mueller, O., Tiendrebéogo, J., Yé, M., & De Allegri, M. (2014). The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso. The European journal of health economics : HEPAC : health economics in prevention and care, 5. doi:10.1007/s10198-013-0553-5.
User fee removal policies have been extensively evaluated in relation to their impact on access to care, but rarely, and mostly poorly, in relation to their impact on household out-of-pocket (OOP) spending. This paucity of evidence is surprising given that reduction in household economic burden is an explicit aim for such policies. Our study assessed the equity impact on household OOP spending for facility-based delivery of the user fee reduction policy implemented in Burkina Faso since 2007 (i.e. subsidised price set at 900 Communauté Financière Africaine francs (CFA) for all, but free for the poorest). Taking into account the challenges linked to implementing exemption policies, we aimed to test the hypothesis that the user fee reduction policy had favoured the least poor more than the poor.
We used data from six consecutive rounds (2006-2011) of a household survey conducted in the Nouna Health District. Primary outcomes are the proportion of households being fully exempted (the poorest 20 % according to the policy) and the actual level of household OOP spending on facility-based delivery. The estimation of the effects relied on a Heckman selection model. This allowed us to estimate changes in OOP spending across socio-economic strata given changes in service utilisation produced by the policy.
A total of 2,316 women reported a delivery between 2006 and 2011. Average household OOP spending decreased from 3,827 CFA in 2006 to 1,523 in 2011, without significant differences across socio-economic strata, neither in terms of households being fully exempted from payment nor in terms of the amount paid. Payment remained regressive and substantially higher than the stipulated 900 CFA.
The Burkinabè policy led to a significant and sustained reduction in household OOP health spending across all socio-economic groups, but failed to properly target the poorest by ensuring a progressive payment system.