Current health care cost recovery systems in the Central African Republic

The study focused on systems which recover a significant amount of facilities" recurrent costs; cost recovery systems were considered financially effective if they recovered at least 45% of operating expenses. The study looked at 35 health facilities (28 public, seven private), including hospitals, health centers, maternity centers, and dispensaries. These facilities use various types of cost recovery systems, with varying levels of success. The authors assessed these facilities" operations and expenses and determined the facilities" self-financing and dependency ratios, to assess the financial health of the facilities and their levels of success with cost recovery. The authors point out that the analysis and comparison of cost recovery rates among the different facilities are made difficult by several problems, including the fact that some facilities receive donations of drugs and other types of subsidies, have low-cost labor, have different fee collection policies, and are in areas of different socioeconomic status and population density. Of the four types of cost recovery systems observed by the study authors, two are recommended for nationwide implementation: fee for service and payment per illness episode. These are the most popular and widely used systems. A household survey is planned to obtain public reaction to these options. Constraints to implementation of a national cost recovery system include: widespread indigence and the difficulty of identifying the poor who are unable to pay fees; relatives of civil servants and others who are required to pay for care currently do not pay at all or receive highly subsidized care; and ministries do not pay for their employees who use health services. The authors recommend that further analyses be performed to improve the management and organization of current systems, and that several steps be taken and problems addressed in preparation for a nationwide cost recovery system. (Author abstract)