The impact of user charges on health outcomes in low-income and middle-income countries: a systematic review

BMJ Global Health
Vicky Mengqi QinJohn Tayu Lee

Abstract

User charges are widely used health financing mechanisms in many health systems in low-income and middle-income countries (LMICs) due to insufficient public health spending on health. This study systematically reviews the evidence on the relationship between user charges and health outcomes in LMICs, and explores underlying mechanisms of this relationship. Published studies were identified via electronic medical, public health, health services and economics databases from 1990 to September 2017. We included studies that evaluated the impact of user charges on health in LMICs using randomised control trial (RCT) or quasi-experimental (QE) study designs. Study quality was assessed using Cochrane Risk of Bias and Risk of Bias in Non-Randomized Studies-of Intervention for RCT and QE studies, respectively. We identified 17 studies from 12 countries (five upper-middle income countries, five lower-middle income countries and two low-income countries) that met our selection criteria. The findings suggested a modest relationship between reduction in user charges and improvements in health outcomes, but this depended on health outcomes measured, the populations studied, study quality and policy settings. The relationship between reduced ...Continue Reading

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Citations

Dec 10, 2020·Journal of Preventive Medicine and Public Health = Yebang Ŭihakhoe Chi·Kiryong NamChang-Yup Kim
Aug 8, 2021·International Journal of Environmental Research and Public Health·Antonio Palazón-BruMaría de Los Ángeles Carbonell-Torregrosa

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