No cash, no care: how user fees endanger health--lessons learnt regarding financial barriers to healthcare services in Burundi, Sierra Leone, Democratic Republic of Congo, Chad, Haiti and Mali.

摘要: Abstract Although user fees are a common form of healthcare financing in resource-poor countries, there is growing consensus that their use compromises health service utilisation and population health. Between 2003 2006, Medecins sans Frontieres (MSF) conducted population-based surveys Burundi, Sierra Leone, Democratic Republic Congo, Chad, Haiti Mali to determine the impact on healthcare-seeking behaviour access. For general disease-specific conditions, MSF also measured (i) reduced payment systems Mali, Burundi (ii) fee abolition for certain groups Mali. User were found result low public facilities, exclusion from care exacerbation impoverishment, forcing many seek alternative care. Financial barriers affected 30–60% people requiring Exemption targeting vulnerable individuals proved ineffective, benefiting only 1–3.5% populations. Alternative systems, ‘modest’ users (e.g. flat fees), did not adequately improve coverage essential needs, especially poorest most vulnerable. Conversely, large led rapid increases services needs. Abolition appears crucial helping reduce existing The challenge authorities donor agencies around working creatively remove while addressing financial consequences improved access providing quality