Health services in many low-income countries charge user fees. These payments may deter the poorest people from seeking treatment. Zambia has tried two alternatives to user fees: prepayment and discount cards. How do these schemes affect equity in the use of health services?sch_iihpub375pu

Kondo, Masahide

McPake, Barbara

Queen Margaret University eResearch

                                                                      eResearch: the open access repository of the research output  of Queen Margaret University, Edinburgh.     This is a copy of the online version of an article published as:   Kondo, Masahide and McPake, Barbara. (2007) Paying their way: health financing mechanisms in Zambia. Id21 Health [online]. Available from: http://www.id21.org/zinter/id21zinter.exe?a=2&i=h1mk5g1&u=49b63ace                              Accessed from:  http://eresearch.qmu.ac.uk/375/  Repository Use Policy  The full-text may be used and/or reproduced, and given to third parties for personal  research or study, educational or not-for-profit purposes providing that: • The full-text is not changed in any way • A full bibliographic reference is made • A hyperlink is given to the original metadata page in eResearch  eResearch policies on access and re-use can be viewed on our Policies page: http://eresearch.qmu.ac.uk/policies.html             http://eresearch.qmu.ac.ukPaying their way: health financing mechanisms in Zambia        Health services in many low-income countries charge user fees. These        payments may deter the poorest people from seeking treatment. Zambia has        tried two alternatives to user fees: prepayment and discount cards. How do        these schemes affect equity in the use of health services?        User fees can help to maintain supplies of drugs and provide bonuses to        motivate health workers. Health centres in Zambia have used varying        combinations of three cost recovery mechanisms:          user charges          prepayment through a monthly insurance scheme, aiming to pool risk          across income groups and between the sick and healthy          discount cards allowing users to buy coupons for cheaper health          services, spreading risk over time and allowing transfer of coupons          between individuals.         What are the equity implications of each option? Research by the        University of Tsukuba, Japan, and Queen Margaret University College,        Edinburgh, UK, focused on the choices people make before they fall ill.        They used economic models to predict that payment mechanisms are chosen        based on the price or premium charged and the timing of payment. Other        influences are the user’s income, their chosen level of health care use        and their perceptions of their own health status and the quality of health        care available.        The researchers looked at six urban health centres: three in Lusaka and        three in Kitwe, using a nationwide household survey, routine health centre        records and an outpatient exit survey. These data suggest that:          Of those who prepay, 62.3 percent in Lusaka and 91.5 percent in Kitwe          subscribe only when they need care and are unlikely to keep up enrolment          once they are well.           Households that do not face a cost at the point of use (through          prepayment or employer coverage) are 2.1 times more likely than others          to use health services in Lusaka and 1.7 times more likely in Kitwe.           Results largely support the idea that prepayment is linked to a higher          service use than discount cards, with the lowest utilisation level found          for user charges.           Income is not a significant factor in choice of payment mechanism, but          smaller households tend to choose prepayment.           Perceived quality is less important than expected in the choice of          payment method.           Discounts cards are chosen mostly by people who live near the health          facility.        The researchers conclude that relative to user charges, prepayment        improves access to care without causing income-related inequity. Discount        cards also aid access, but to a lesser extent, and are more likely to        produce income-related equity losses, favouring people who already have        greater access to services. Interrupted subscription is common in        prepayment schemes. Discount cards may offer a middle ground: giving        better equity and access than user charges while protecting against the        abuses of prepayment schemes.        The range of options for policy-makers includes:          using monthly rather than annual prepayment to reduce income inequities,          paying attention to problems such as interrupted enrolment and higher          administrative costs          learning from health centres with the most successful prepayment schemes          to reduce abuses of the system elsewhere          conducting a better resourced and monitored trial before introducing          discount cards.         Source(s):       ‘Making choices between prepayment and user charges in Zambia. What are        the results for equity?’, Health Economics, by Masahide Kondo and Barbara        McPake, 2007 (in press)        id21 Research Highlight: 28 August 2007       Further Information:       Masahide Kondo       Department of Health Care Policy and Management       University of Tsukuba       1-1-1, Tennoudai       Tsukuba       Ibaraki 305-8577       Japan       Contact the contributor:                             Views expressed on these pages are not necessarily those of DFID,              IDS, id21 or other contributing institutions. Unless stated              otherwise articles may be copied or quoted without restriction,              provided id21 and originating author(s) and institution(s) are              acknowledged.                           id21 is funded by the UK Department for International Development              and is one of a family of knowledge services at the Institute of              Development Studies www.ids.ac.uk at the University of Sussex. IDS              is a charitable company, No. 877338.              Copyright © 2009 id21. All rights reserved.              Week beginning Monday 9th February 2009   

Paying their way: health financing mechanisms in Zambia

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Health services in many low-income countries charge user fees. These payments may deter the poorest people from seeking treatment. Zambia has tried two alternatives to user fees: prepayment and discount cards. How do these schemes affect equity in the use of health services

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Paying their way: health financing mechanisms in Zambia

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