Quality of health care and its role in cost recovery in Africa : cost recovery and improved drug availability in Niger - implications for total patient treatment costs -- phases 2 and 3 : field work, research results, and policy recommendations

Using quasi-experimental design methods, this study investigated, for a cost recovery intervention in Niger, how the total costs of an episode of treatment for an acute illness for a typical patient changed when user fees were imposed but accompanied by an improved drug supply. Episode costs included both cash expenses and opportunity costs of time. The study was conducted in two intervention districts (Say and Boboye) and a control district (Illela), where no cost recovery was implemented. Two user fee systems were investigated: in Say, the patient paid a lump sum per one-week episode; in Boboye he/she paid an annual earmarked health tax and a small co-payment per episode. Extensive household and facility data were collected before and after implementation of the cost recovery intervention. With few exceptions, comparisons of both unadjusted and adjusted patient episode costs showed that total episode costs in the intervention sites increased relative to the control site. The findings showed mixed results when comparing Say and Boboye. Using unadjusted episode cost averages, Boboye experienced a greater percentage decline than Say for the general population, for the poor, and for children under 15; an equivalent percentage decline for malaria-like cases; and a smaller percentage decline for females. In contrast, using adjusted episode costs, Boboye had relatively higher increases in episode costs than Say for all population groups. Includes references. (Author abstract, modified))