Adequate health financing is a critical
element of any strong healthcare system.
In Sub-Saharan Africa, financing and payment models for primary,
secondary, and tertiary health care can be significant tools for improving
issues of access, quality, and equity in care delivery. While much effort is made to understand the
financing approaches that may be optimal for health systems at large, little is
known about financing mechanisms that may work best considering the dominance
of out-of-pocket payment and, more importantly, the impact that unexpected,
informal costs for care may have on health-seeking behaviour. The abolition of user fees for public health
facilities has become increasingly popular in many low-income countries, with
results from numerous studies noting an increase in access and utilization for
the poorest populations. However,
abolishing user fees often does not remove the cost of many goods and services
related to a care episode. Though some
patients may pay no initial fees for a basic service such as an initial
consultation, there are often treatment-related costs that are unknown to the
patient.
Even with health insurance or under “free”
social schemes, evidence suggests that many patients in Nigeria’s public health
facilities still pay a significant amount of care-related costs. The discrepancy between the expected free
cost of care at public facilities and the actual cost of treatment often means
that poorer patients pay as they are able to gather funds. Abolition of user fees and fee exemptions may
not effectively protect access to health services among the poor. The majority of fee removal and exemption
mechanisms have not meant an end to the existence of informal fees and other
care-related costs. A better understanding is needed of the existence of fee
removal mechanisms, whether they are able to increase access for the poor, or
if other supplemental mechanisms may be necessary.
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