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How do you bring health care to the poor?
Date:9/29/2011

icher people in the community and then pay physicians to treat the poor for free.

But who is poor, and who decides so? When somebody presents at the hospital, it is too late to decide if they can be considered as poor, because many poor never present at the hospital in the first place. If they know beforehand that they are entitled to free care, they will look for care more easily. Defining who's entitled can be done best within the local community, that knows who are its poor members. Thanks to this identification system more poor people contact physicians and hospitals.

Jacobs also examined the supply side: does it make sense for the authorities to abolish user fees for certain groups, or to monitor the performance of health care providers?

After the introduction of user fees whereby patients (partly) pay for the care they receive however strange it may seem, more patients showed up at the hospital. Because they had the feeling they were better taken care of, by better paid and therefore better motivated doctors. Unfortunately the extra patients were (relatively) rich; the poor did not show up more. Even in the case of free care, they need to lend money, because travel costs an loss of income are not covered. The health equity funds now also incorporate those costs.

In the mean time, partly due to Jacobs' results, Cambodia started with a nationwide identification of the poor, and stimulated the head monks of pagoda's everywhere to also create a pagoda health equity fund in their region. The pagoda system now reaches some 300 000 poor.


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Contact: Bart Jacobs
bart.jacobs@luxdev.lu
Institute of Tropical Medicine Antwerp
Source:Eurekalert

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