Evidence map›Paper›PMID 30792908›Full record

ArticleBMJ global health2018

The impact of user charges on health outcomes in low-income and middle-income countries: a systematic review.

Vicky Mengqi Qin, Thomas Hone, Christopher Millett, Rodrigo Moreno-Serra, Barbara McPake, Rifat Atun, John Tayu Lee

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In one paragraph

Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Vicky Mengqi QinSaw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Thomas HonePublic Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK.ORCID 0000-0003-0703-6973
Christopher MillettPublic Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK.
Rodrigo Moreno-SerraCentre for Health Economics, University of York, York, UK.
Barbara McPakeNossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Rifat AtunDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
John Tayu LeePublic Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK.

Funding

Medical Research Council G1002338
6 · The paper itself

Abstract

backgroundUser charges are widely used health financing mechanisms in many health systems in low-income and middle-income countries (LMICs) due to insufficient public health spending on health. This study systematically reviews the evidence on the relationship between user charges and health outcomes in LMICs, and explores underlying mechanisms of this relationship.

methodsPublished studies were identified via electronic medical, public health, health services and economics databases from 1990 to September 2017. We included studies that evaluated the impact of user charges on health in LMICs using randomised control trial (RCT) or quasi-experimental (QE) study designs. Study quality was assessed using Cochrane Risk of Bias and Risk of Bias in Non-Randomized Studies-of Intervention for RCT and QE studies, respectively.

resultsWe identified 17 studies from 12 countries (five upper-middle income countries, five lower-middle income countries and two low-income countries) that met our selection criteria. The findings suggested a modest relationship between reduction in user charges and improvements in health outcomes, but this depended on health outcomes measured, the populations studied, study quality and policy settings. The relationship between reduced user charges and improved health outcomes was more evident in studies focusing on children and lower-income populations. Studies examining infectious disease-related outcomes, chronic disease management and nutritional outcomes were too few to draw meaningful conclusions. Improved access to healthcare as a result of reduction in out-of-pocket expenditure was identified as the possible causal pathway for improved health.

conclusionsReduced user charges were associated with improved health outcomes, particularly for lower-income groups and children in LMICs. Accelerating progress towards universal health coverage through prepayment mechanisms such as taxation and insurance can lead to improved health outcomes and reduced health inequalities in LMICs. TRIAL REGISTRATION NUMBER: CRD 42017054737.

Indexed as

cost sharinghealth systems financingpopulation healthuser chargesuser fees

Identifiers

PMID30792908
PMCPMC6350744

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.