User–fee–removal improves equity of children’s health care utilization and reduces families’ financial burden: evidence from Jamaica

Abstract

User-fee-removal improves equity of children's health care utilization and reduces families' financial burden: evidence from Jamaica Background The impact of user-fee policies on the equity of health care utilization and households' financial burdens has remained largely unexplored in Latin American and the Caribbean, as well as in upper-middle-income countries.This paper assesses the short-and long-term impacts of Jamaica' s user-fee-removal for children in 2007. MethodsThis study utilizes 14 rounds of data from the Jamaica Survey of Living Conditions (JSLC) for the periods 1996 to 2012.JSLC is a national household survey, which collects data on health care utilization and among other purposes for planning.Interrupted time series (ITS) analysis was used to examine the immediate impact of the userfee-removal policy on children' s health care utilization and households' financial burdens, as well as the impact in the medium-to long-term. ResultsImmediately following the implementation of user-fee-removal, the odds of seeking for health care if the children fell ill in the past 4 weeks increased by 97% (odds ratio 2.0, 95% confidence interval (CI) 1.1 to 3.5, P = 0.018).In the short-term (2007)(2008), health care utilization increased at a faster rate among children not in poverty than children in poverty; while this gap narrowed after 2008.There was minimal difference in health care utilization across wealth groups in the medium-to long-term.The household' s financial burden (health expenditure as a share of household' s non-food expenditures) reduced by 6 percentage points (95% CI: -11 to -1, P = 0.020) right after the policy was implemented and kept at a low level.The difference in financial burden between children in poverty and children not in poverty shrunk rapidly after 2007 and remained small in subsequent years.Conclusions User-fee-removal had a positive impact on promoting health care utilization among children and reducing their household health expenditures in Jamaica.The short-term and the medium-to long-term results have different indications: In the short-term, the policy deteriorated the equity of access to health care for children, while the equity status improved fast in the medium-to long-term.

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