1. In Madagascar, Use Of Health Care Services Increased When Fees Were Removed: Lessons For Universal Health Coverage
- Author
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Paul Farmer, Laura Lee Hall, Damoela Randriantsimaniry, Megan Murray, Andres Garchitorena, Victor R Rabeza, Ann C. Miller, Arthur Velo Orlan, Djordje Gikic, Matthew H. Bonds, Alexandre Rabemampionona, Michael Rich, Laura F Cordier, Ranto Ramananjato, Amber Cripps, and Germain Rakotozafy
- Subjects
medicine.medical_specialty ,education.field_of_study ,HRHIS ,business.industry ,Health Policy ,030231 tropical medicine ,Population ,Psychological intervention ,Health equity ,03 medical and health sciences ,0302 clinical medicine ,Health promotion ,Family medicine ,Environmental health ,Health care ,medicine ,030212 general & internal medicine ,Rural area ,education ,business ,Health policy - Abstract
Despite overwhelming burdens of disease, health care access in most developing countries is extremely low. As governments work toward achieving universal health coverage, evidence on appropriate interventions to expand access in rural populations is critical for informing policies. Using a combination of population and health system data, we evaluated the impact of two pilot fee exemption interventions in a rural area of Madagascar. We found that fewer than one-third of people in need of health care accessed treatment when point-of-service fees were in place. However, when fee exemptions were introduced for targeted medicines and services, the use of health care increased by 65 percent for all patients, 52 percent for children under age five, and over 25 percent for maternity consultations. These effects were sustained at an average direct cost of US$0.60 per patient. The pilot interventions can become a key element of universal health care in Madagascar with the support of external donors.
- Published
- 2017
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