Bulletin of the World Health Organization

The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence?

Mylene Lagarde, Natasha Palmer

Volume 86, Number 11, November 2008, 839-848

Table 1. Inclusion criteria applied in review of studies of the effects of user fees on health service utilization in low- and middle-income countries

Type of intervention A change in the payment required from patients at the point of service delivery

Outcome measures Utilization of services (including equity outcomes)
Health expenditures
Health outcomes

Study setting Low- and middle-income countries (as defined by The World Bank)
Preventive and curative services, all levels

Study design C-RCT
CBA study
ITS study – two criteria had to be met:
• analysis using ITS method, or allowing access to the data series for reanalysis
• providing routine data (weekly, monthly or quarterly)a over a period long enough to provide at least 10 data points before and after the policy changeb

CBA, controlled “before and after”; C-RCT, cluster randomized controlled trial; ITS, interrupted time series.a Yearly data were discarded on the grounds that they would not provide detailed information or capture the moment of change.b This criterion was added to limit the biases that would arise from analysing a very limited dataset.

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