Cost Recovery in Public Health Services in Sub-Saharan Africa

Nolan, Brian

doi:10.1596/0-8213-3240-6

Cited by 37 publications

(41 citation statements)

References 20 publications

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“…The revenue-raising potential of user charges has in practice proven to be mixed and generally well below the initially anticipated 10±20 per cent of total government recurrent health expenditure (Vogel, 1988(Vogel, , 1991Barnum and Kutzin, 1993;Nolan and Turbat, 1995). At the national level, fee systems are estimated to yield gross revenues of about 5 per cent of operating costs in Africa with a wide variation range of as high as 12 per cent in Ghana and as low as less than 1 per cent in Burkina Faso (Vogel, 1988(Vogel, , 1991Nolan and Turbat, 1995).…”

Section: Revenue-raising Potential Of User Chargesmentioning

confidence: 97%

“…At the national level, fee systems are estimated to yield gross revenues of about 5 per cent of operating costs in Africa with a wide variation range of as high as 12 per cent in Ghana and as low as less than 1 per cent in Burkina Faso (Vogel, 1988(Vogel, , 1991Nolan and Turbat, 1995). A much higher cost recovery ratio has been reported for individual health facilities and some isolated small community projects.…”

Section: Revenue-raising Potential Of User Chargesmentioning

confidence: 99%

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Are user charges efficiency‐ and equity‐enhancing? A critical review of economic literature with particular reference to experience from developing countries

Sepehri

Chernomas

2001

J of Intl Development

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User charges have come to play a significant role in the financing and delivery of publicly provided health services in many developing countries. As a response to health care financing crises, user charges are often promoted as a way of rationalizing the use of care, raising revenue, and improving the coverage and quality of services. The primary purpose of this paper is to provide a critical review of the main arguments for the efficiency- and equity-enhancing potential of user charges. The extent and scope of welfare gains from user charges are found to be very limited in practice. Using a less restrictive theoretical choice model and estimation technique, the most recent demand studies' findings indicate that household's utilization of health services are more responsive to changes in price and income than was initially reported by the early demand studies. Response to price changes are also found to be greater among the poor than the rich. These findings, combined with modest retained fee revenues and the failure of exemption mechanisms to protect the poor tend to cast doubt on the net benefits of user charges policy, particularly in the area of equity. Copyright © 2001 John Wiley & Sons, Ltd.

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Section: Revenue-raising Potential Of User Chargesmentioning

confidence: 97%

Section: Revenue-raising Potential Of User Chargesmentioning

confidence: 99%

Are user charges efficiency‐ and equity‐enhancing? A critical review of economic literature with particular reference to experience from developing countries

Sepehri

Chernomas

2001

J of Intl Development

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“…[36,37] It has been shown that as against the expected, these fees yielded only twelve percent of the gross operating costs for health services in countries like Ghana and a meagre one percent in Burkina Faso. [38,39] Approximately, most national user fee systems in the region have generated only about five percent of total recurrent health system expenditures and gross administrative costs [35,39,40].…”

Section: Resource Mobilization and Cost Recoverymentioning

confidence: 99%

The Impacts of User Fees on Health Services in Sub-Saharan African Countries: A Ctirical Analysis of the Evidence

John¹

2013

AJPHR

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The momentum towards achieving the United Nations Millennium Development Goals re-invigorated concerns around sustainable health care financing and the adequacy of the financing arrangements in many lowresource settings. Accordingly, this necessitated the institution of user-fees as part of health financing reform in many countries in sub-Saharan Africa. These fees are charges levied at the point of service with the intent of reducing 'frivolous' consumption of health services, increasing the quality of services available and at the same time increasing coverage and utilisation of services. Likewise, as a 'decisive' policy to cushion the existing challenges facing health care financing in the region, a critical assessment of the assertions of proponents of user fees who use the principle of cost recovery and revenue mobilization to drive the concept of rational utilization, efficiency and equitable distribution of health care services is often exaggerated. As it were, the available evidence suggests that user fees alone will not likely accomplish equity, efficiency, or the sustainability objectives in health services in the region. What is critical is that user fees should be linked to the broader package of financing -such as insurance coverage-and with a view to averting any form of equity danger that may thus arise.

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“…The impact of user fees, and therefore pricing, on equity and health care access was largely controversial in the literature (Nolan and Turbat, 1995;Reddy and Vandemoortele, 1996;Creese, 1997;Gertler and Hammer, 1997;Gilson, 1997;Xu et al, 2006). Most of the observers concur that pricing often leads to inequity in terms of financial access: price scales, depending on the level of prices applied, is discriminating according to patients' level of income as the poorest and the most vulnerable groups (women and children) have more limited access to health care than other groups in the population, particularly because, for a same amount, the cost of care absorbs a much more higher share of their income (Fabricant et al, 1996;Juillet, 1999;Makinen et al, 2000;Meuwissen, 2002;Ridde, 2002;Buor, 2004).…”

Section: Effectiveness and Effects Of Pricing Policymentioning

confidence: 99%

Analysis of hospital costs as a basis for pricing services in Mali

Audibert¹,

Mathonnat

Pareil

et al. 2007

Health Planning & Management

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In a move to achieve a better equity in the funding of access to health care, particularly for the poor, a better efficiency of hospital functioning and a better financial balance, the analysis of hospital costs in Mali brings several key elements to improve the pricing of medical services. The method utilized is the classical step-down process which takes into consideration the entire set of direct and indirect costs borne by the hospital. Although this approach does not allow to estimate the economic cost of consultations, it is a useful contribution to assess the financial activity of the hospital and improve its performance, financially speaking, through a more relevant user fees policy. The study shows that there are possibilities of cross-subsidies within the hospital or within services which improve the recovery of some of the current costs. It also leads to several proposals of pricing care while taking into account the constraints, the level of the hospital its specific conditions and equity.

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Cost Recovery in Public Health Services in Sub-Saharan Africa

Cited by 37 publications

References 20 publications

Are user charges efficiency‐ and equity‐enhancing? A critical review of economic literature with particular reference to experience from developing countries

Are user charges efficiency‐ and equity‐enhancing? A critical review of economic literature with particular reference to experience from developing countries

The Impacts of User Fees on Health Services in Sub-Saharan African Countries: A Ctirical Analysis of the Evidence

Analysis of hospital costs as a basis for pricing services in Mali

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