Recouvrement des coûts et demande de soins dans les PED

Abstract

[fre] Boubou Cissé Stéphane Luchini Jean-Paul Moatti Recouvrement des coûts et demande de soins dans les PED Suite à la crise financière qui a durement frappé les pays en développe- ment dès le début des années 1980, l'instauration du recouvrement des coûts d'accès aux soins (politique de tarification des prestations de services de santé) a été proposée à ces pays en 1985 puis en pratique exigée par la Banque mondiale à partir de 1987. Depuis lors, il y a eu de nombreuses controverses autour de l'impact de œs systèmes de recouvrement des coûts sur l'accès aux soins et l'utilisation des services de santé. Le but de cet article est de procéder à l'analyse de ces écrits afin de faire le point sur les constats et les interrogations suggérés par ces études passées et en cours, et dégager de nouvelles pistes de recherche pour une meilleure analyse théorique et empirique de la demande de soins dans les PED. [eng] Cost Recovery and Health Care Demand in Developing Countries Further to the 1980s financial crisis which has sorely stroked the developing countries, the establishment of the cost recovery scheme (user fees) has been proposed to these countries in 1985, and in practise demand from the World Bank from 1987. Since then, there has been many controversies about the impact of the introduction of user fees on access to health care and utilisation of health services. The purpose of this work is to analyse these writings in other to take stock of the findings and questions suggested by these past and on the way studies, and propose new research tracks for a better theoretical and empirical analysis of health care demand in developing countries.

Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

“…Moreover, the level of education of the household head influences the expected health status of household members and therefore the use of formal health centers. Our results corroborate those from studies of households in sub-Saharan Africa, such as those of Eme Ichoku and Leibbrandt in Nigeria [ 52 ], Muriithi in Kenya [ 49 ], and Cissé et al [ 53 ] in the Ivory Coast. These results are, however, in contradiction to those of Gertler and Van der Gaag [ 54 ], who showed that the level of education of the head of household had no statistically significant relation with the seeking of health care.…”

From institutionalization of user fees to their abolition in West Africa: a story of pilot projects and public policies

“…As we saw above, these utilization levels, while often higher than before, were nevertheless very low, and remained low 20 years after the fact. A synthesis article showed that some pilot projects even asserted that quality improvements could offset the negative impact of introducing user fees [ 73 ]. In Cameroon, for example, user fees without any quality improvement had negative impacts on the use of services by the worst-off.…”

“…On the other hand, other studies then explained that the links between price, quality, and utilization are more complex than that, and that the different aspects of each of these dimensions can affect outcomes. Quality improvement does not automatically compensate for negative effects of higher prices on service utilization [ 73 ].…”

Impoverishment and patients’ “willingness” and “ability” to pay for improving the quality of health care in Palestine: An assessment using the contingent valuation method

“…Most of the patients had some form of health care insurance coverage (81.5%), for the most part a governmental insurance scheme (>95%). More than half of respondents received the service free 4 The test is based on augmented regression including squares and cubics of the fitted values. The auxiliary augmented model is:…”

“…Many governments responded by implementing stabilization and structural adjustment programs [3], proposed and subsequently demanded by international organizations, e.g., the World Bank [4] and the International Monetary Fund [5]. Hence, these states were obliged to restrict their social expenditures including health care budgets [6], with the risk of compromising the provision of good quality care.…”