For BIA, Wagstaff 17 recently argued that the two key assumptions often made the constant unit subsidy assumption and the constant unit cost assumption may produce different pictures of equity in the distribution of government health spending, depending on the nature of utilisation and fees paid to public providers.
The average marginal effect of a variable measures how much the expected FFS changes as the variables increase by one unit.> -wrap-foot> Association between GP services utilisation estimated by fee-for-service (FFS) per patient in 2009 and characteristics of patients, GPs, GP practices, and practice municipality for patients aged 25 60 with schizophrenia or diabetes, and the whole population.
There has been growing interest for the implementation of social health insurance in most developing countries fuelled in part by the negative repercussion of user fees on utilisation rates and healthcare management.
Utilisation of Government established fee schedules as a broad indicator of the cost of services may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.
General questions were asked to gather background information on the following: the facility, implementation of the user fee policy (for facilities that removed fees), trend in utilisation rates, revenue from user fees, drug management, and overall perception of the impact of the policy change.
In conclusion, this study adds some evidence that subsidising user fees may increase utilisation in the short-term, and it is hoped that donors and government will embrace these findings when deciding on health financing policy, particularly as there is not yet a consensus view.
This may be explained by the fact that these health system strengthening measures alone are not enough to sufficiently improve health-care utilisation; the addition of user fee subsidisation may further increase rates of health-care utilisation.
One strength of our study is that it took into account potential sources of bias, such as autocorrelation, which often arise in the analysis of routine longitudinal data [ 25], and used the methodology set out in a recent Cochrane systematic review which concluded that more rigorous research on the effects of user fees on health-care utilisation was needed [ 6].
Most studies reviewing utilisation following the removal of user fees for deliveries have found a rise in assisted deliveries and caesarean sections at health facilities [ 21, 24- 26] and, in some cases, found that gains are greater in poorer groups [ 27].
