Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review.

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Title: Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review.
Author(s): Hone, T
Lee, JT
Majeed, FA
Conteh, L
Millett, C
Item Type: Journal Article
Abstract: Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients.
Publication Date: 20-Jan-2017
Date of Acceptance: 19-Dec-2016
URI: http://hdl.handle.net/10044/1/45116
DOI: https://dx.doi.org/10.1093/heapol/czw178
ISSN: 1460-2237
Publisher: Oxford University Press (OUP)
Start Page: 723
End Page: 731
Journal / Book Title: Health Policy and Planning
Volume: 32
Issue: 5
Copyright Statement: © 2017 The Author(s). Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in Health Policy and Planning following peer review. The definitive publisher-authenticated version Thomas Hone, John Tayu Lee, Azeem Majeed, Lesong Conteh, Christopher Millett; Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review. Health Policy Plan 2017 czw178. doi: 10.1093/heapol/czw178 is available online at: https://dx.doi.org/10.1093/heapol/czw178
Keywords: Primary healthcare
systematic review
user fees
Health Policy & Services
1605 Policy And Administration
1117 Public Health And Health Services
Publication Status: Published
Conference Place: England
Embargo Date: 2018-01-20
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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