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Free health care: Yes, but with caution
Date:10/27/2011

ANTWERP Over the last years, many low and middle-income countries have removed user fees in their health care sector. Researchers from Africa, Asia, Northern America and Europe have studied these policies; their findings are gathered in a supplement of the scientific journal Health Policy & Planning, coordinated by Bruno Meesen from the Antwerp Institute of Tropical medicine. Experiences from Afghanistan, Burundi, Burkina Faso, Mali, Nepal , Rwanda and Uganda, among others, are documented in this supplement. Conclusion: it is possible, but should not be done ill-advised.

The main lessons from their analyses are the following ones:

  • These policies are often decisions taken by the highest country authorities; sometimes during electoral campaigns
  • Many countries are opting for selective free health care (e.g. free health care for children under 5, free delivery). This allows a good alignment on the Millennium Development Goals and is probably reasonable, given the costs of free health care policies.
  • When these decisions are taken in a hasty manner without sufficient consultation of stakeholders (including technicians working for the concerned ministries), health systems may experience a shock (difficulty to cope with the increase in patients; drug shortages).
  • When these policies are well-designed, implemented with the appropriate accompanying measures and sufficiently funded, they can improve access to health services. Insufficient funding may however imply that the increased utilisation by the population paradoxically leads households to spend more for their treatment (for instance, because of drug shortages in free public health facilities, households may have to buy their drugs in private pharmacies).
  • There are different ways to reduce financial barriers to health care; free health care is an option, health insurance is another. Any good solution for the vulnerable populations and the public budget will requi
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Contact: Bruno Meesen
bmeessen@itg.be
32-324-76292
Institute of Tropical Medicine Antwerp
Source:Eurekalert

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