The impact of alternative cost recovery schemes on access and equity in Niger

The authors examine accessibility and the sustainability of quality health care in a rural setting under two alternative cost recovery methods, a fee-for-service method and a type of social financing (risk-sharing) strategy based on an annual tax + fee-for-service. Both methods were accompanied by s...

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Bibliographic Details
Published in:Health policy and planning 1995-09, Vol.10 (3), p.223-240
Main Authors: DIOP, FRANCOIS, YAZBECK, ABDO, BITRAN, RICARDO
Format: Article
Language:English
Subjects:
Access
Cost Sharing
Data Collection
Equity
Factors
Fee-for-Service Plans
Financing
Health administration
Health Care
Health Care Costs
Health Care Reform - economics
Health planning
Health policy
Health Services
Health Services Accessibility - economics
Health Services Accessibility - statistics & numerical data
Health Services Research
Medical Indigency
Niger
Pilot Projects
Population
Public health
Quality of Health Care
Regression Analysis
Rural Areas
Rural Health Services - economics
Taxation
Taxes
Willingness-to-pay
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Summary:The authors examine accessibility and the sustainability of quality health care in a rural setting under two alternative cost recovery methods, a fee-for-service method and a type of social financing (risk-sharing) strategy based on an annual tax + fee-for-service. Both methods were accompanied by similar interventions aimed at improving the quality of primary health services. Based on pilot tests of cost recovery in the non-hospital sector in Niger, the article presents results from baseline and final survey data, as well as from facility utilization, cost, and revenue data collected in two test districts and a control district. Cost recovery accompanied by quality improvements increases equity and access to health care and the type of cost recovery method used can make a difference. In Niger, higher access for women, children, and the poor resulted from the tax + fee method, than from the pure fee-for-service method. Moreover, revenue generation per capita under the tax + fee method was two times higher than under the fee-for-service method, suggesting that the prospects of sustainability were better under the social financing strategy. However, sustainability under cost recovery and improved quality depends as much on policy measures aimed at cost containment, particularly for drugs, as on specific cost recovery methods.
ISSN:0268-1080
1460-2237
DOI:10.1093/heapol/10.3.223