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首页> 外文期刊>Journal of Health Services Research & Policy >Assessing the effects of removing user fees in Zambia and Niger
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Assessing the effects of removing user fees in Zambia and Niger

机译：评估免除赞比亚和尼日尔用户费用的影响

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Objectives: This study aims to overcome some of the limitations of previous studies investigating the effects ofnfee removal, by looking at heterogeneity of effects within countries and over time, as well as the existence of spill-nover effects on groups not targeted by the policy change.nMethods: Using routine district health services data before and after recent abolitions of user charges innZambia and Niger, we examine the effects of the policy change on the use of health services by differentngroups and over time, using an interrupted timeseries design.nResults: Removing user fees for primary health care services in rural districts in Zambia and for children overnfive years old in Niger increased use of services by the targeted groups. The impact of the policy change differednwidely across districts, ranging from 112% and 1194% in Niger to 239% and 1108% in Zambia. Eighteennmonths after the policy change, some of these effects had been eroded. There was evidence that abolishingnuser fees can both have positive and negative spillover effects.nConclusion: These results highlight the importance of paying attention to implementation challenges andnmonitoring the effects of policy reforms which are often more mixed and complicated that they appear. Thencomparison of these reforms in two countries also sheds light on the potentially different ways in which freencare can be used as a tool to improve access.
机译：目标：本研究旨在通过研究国家内部和长期影响的异质性，以及对非政策变更目标人群的溢出溢出效应的存在，来克服以往研究除臭效果的研究的某些局限性.nMethods：使用最近在赞比亚和尼日尔取消用户收费前后的常规地区卫生服务数据，我们使用中断的时间序列设计来研究政策变更对不同人群和随着时间推移卫生服务使用的影响。赞比亚农村地区的初级卫生保健服务的用户费用以及尼日尔超过五岁的儿童的用户费用增加了目标群体对服务的使用。政策变化的影响在各个地区之间差异很大，从尼日尔的112％和1194％到赞比亚的239％和1108％。政策变更后的18个月，其中一些影响已被侵蚀。有证据表明，取消用户费用会产生正向和负向的溢出效应。n结论：这些结果凸显了关注实施挑战和监督政策改革的效果的重要性，因为政策改革的效果往往更为复杂和复杂。然后，对这两个国家进行的这些改革进行了比较，也揭示了免费护理可以用作改善获取机会的工具的潜在不同方式。

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