August, 2008 - SUPPORT Summary of a systematic review | print this article |
The introduction of user charges in many low and middle-income countries has been proposed as a strategy to increase revenues. But delayed treatment, catastrophic health expenditures and impoverishment are among the detrimental effects attributed to them. To reduce these risks, mechanisms allowing payment of care in advance or risk pooling have been increasingly advocated.
The review included one controlled before-after study that evaluated a communitybased health insurance scheme in Rwanda. Enrolment in the scheme was voluntary and allowed access to a benefit package which included all preventive and curative services provided in the health centre, including essential drugs (as listed by the Ministry of Health). The only relevant outcomes collected before and after the beginning of the programme were monthly routine data from facilities located in the intervention and control districts. Health utilization outcomes measured by utilization of all available services in health centres (curative outpatient visits, prenatal care visits, deliveries, family planning, vaccinations, laboratory, hospitalization admissions and days) and in hospitals (curative outpatient visits, curative inpatient visits, deliveries, laboratory and radological tests, hospitalisation by ward, hospitalisation days). The volume of essential drugs prescribed in health centres and hospitals was also monitored.
This systematic review is currently in press: Lagarde M, Palmer N. The impact of risk sharing mechanisms on access to health services in low and middle-income countries. Cochrane Database of Systematic Reviews.
The protocol for the systematic review above: The impact of health financing strategies on access to health services in low and middle-income countries (Protocol). Cochrane Database of Systematic Reviews 2006, Issue 3.
This chapter summarizes the financing mechanisms of health systems: The world health report 2000 -Health systems: improving performance. Chapter 5: Who pays health systems?. Geneva: WHO, 2000. http://www.who.int/whr/2000/en/whr00_ch5_en.pdf
Systematic review addressing the impact of community-based health insurance: Ekman B. Communitybased health insurance in low-income countries: a systematic review of the evidence. Health Policy Plan 2004; 19:249-70.
Review: Creese A, Bennett S. Rural risk-sharing strategies. In: Schieber G (ed.). Innovations in Health Care Financing. Proceedings of a World Bank Conference. Washington, D.C: World Bank, 1997, pages 163-93. http://books.google.com/books?id=bDIl8bDJXe0C&printsec=frontcover
García Marti Sebastían and Ciapponi Agustín. Institute for Clinical Effectiveness and Health Policy. Argentina
None declared. For details, see: http://www.support-collaboration.org/summaries/coi.htm
This summary has been peer reviewed by: Tracey Perez Koehlmoos, Bangladesh; Gabriel Rada, Chile.
García Martí S, Ciapponi A. Does risk sharing mechanisms improve access to health services in low and middle income countries? A SUPPORT Summary of a systematic review. August 2008. http://www.supportcollaboration.org/summaries.htm