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 6. Main characteristics of studies on increasing user fees and its effects on health service utilization in low- and middle-income countries, according to literature review
| Study | Study setting | Study design | Intervention | Quality assessment | Overall Risk of bias |
|---|---|---|---|---|---|
| Bennett (1989) |
Lesotho – 4 district hospitals and 3 private not-for-profit (controls from a unique district) | ITSa | Increase of user fees in PHC facilities with some control data | Limited data (weekly series over 1 year) cannot account for seasonal variations; no information on contextual factors; intervention and control sites not equivalent; use of routine data, potentially unreliable; data reanalysed to account for their longitudinal nature | High |
| Issifou & Kremsner (2004) |
Gabon – a private (for profit) hospital and a public one (control) | CBA | Increase of consultation fees in a private hospital | Non-equivalence of intervention and control sites; use of routine data, potentially unreliable; data reanalysed to account for their longitudinal nature | High |
| Bratt et al. (2002) |
Ecuador – 5 blocks of 3 clinics each (each block has 2 treatment sites and 1 control) | C-RCT | Increase of user fees for reproductive health services in private not-for-profit clinics – pilot study | Limited number of clusters; clustering effects mentioned (and controlled for) in only one analysis; discrepancies between control and intervention groups; biased sample (clinics’ patients are better off than national average) | High |
CBA, controlled “before and after”; C-RCT, cluster randomized controlled trial; ITS, interrupted time series; PHC, primary health care.a Longitudinal data were reanalysed by the authors of the review, so that the results do not necessarily reflect the conclusions and views of the authors of the original paper.