Philibert Aline, Ridde Valéry, Bado Aristide, Fournier Pierre
Biology Department, University of Ottawa (UdO), 325 MacDonald Hall, 150 Louis Pasteur, Ottawa, ON K1N 6 N5, Canada.
BMC Health Serv Res. 2014 Mar 11;14:120. doi: 10.1186/1472-6963-14-120.
Although many developing countries have developed user fee exemption policies to move towards universal health coverage as a priority, very few studies have attempted to measure the quality of care. The present paper aims at assessing whether women's satisfaction with delivery care is maintained with a total fee exemption in Burkina Faso.
A quasi-experimental design with both intervention and control groups was carried out. Six health centres were selected in rural health districts with limited resources. In the intervention group, delivery care is free of charge at health centres while in the control district women have to pay 900 West African CFA francs (U$2). A total of 870 women who delivered at the health centre were interviewed at home after their visit over a 60-day range. A series of principal component analyses (PCA) were carried out to identify the dimension of patients' satisfaction.
Women's satisfaction loaded satisfactorily on a three-dimension principal component analysis (PCA): 1-provider-patient interaction; 2-nursing care services; 3-environment. Women in both the intervention and control groups were satisfied or very satisfied in 90% of cases (in 31 of 34 items). For each dimension, average satisfaction was similar between the two groups, even after controlling for socio-demographic factors (p = 0.436, p = 0.506, p = 0.310, respectively). The effects of total fee exemption on satisfaction were similar for any women without reinforcing inequalities between very poor and wealthy women (p ≥ 0.05). Although the wealthiest women were more dissatisfied with the delivery environment (p = 0.017), the poorest were more highly satisfied with nursing care services (p = 0.009).
Contrary to our expectations, total fee exemption at the point of service did not seem to have a negative impact on quality of care, and women's perceptions remained very positive. This paper shows that the policy of completely abolishing user fees with organized implementation is certainly a way for developing countries to engage in universal coverage while maintaining the quality of care.
尽管许多发展中国家已制定免除用户费用政策，将实现全民健康覆盖作为优先事项，但很少有研究试图衡量医疗服务质量。本文旨在评估布基纳法索实行全额费用免除后，妇女对分娩护理的满意度是否得以维持。
采用设有干预组和对照组的准实验设计。在资源有限的农村卫生区选择了六个卫生中心。干预组在卫生中心分娩护理免费，而在对照区妇女需支付900西非法郎（2美元）。在60天内，共有870名在卫生中心分娩的妇女在产后接受了家访。进行了一系列主成分分析（PCA）以确定患者满意度的维度。
在三维主成分分析（PCA）中，妇女的满意度表现良好：1-医患互动；2-护理服务；3-环境。干预组和对照组的妇女在90%的情况下（34项中的31项）表示满意或非常满意。对于每个维度，即使在控制了社会人口因素后，两组的平均满意度也相似（分别为p = 0.436、p = 0.506、p = 0.310）。全额费用免除对满意度的影响对于任何妇女来说都是相似的，没有加剧极贫困和富裕妇女之间的不平等（p≥0.05）。尽管最富裕的妇女对分娩环境更不满意（p = 0.017），但最贫困的妇女对护理服务满意度更高（p = 0.009）。
与我们的预期相反，服务点的全额费用免除似乎并未对医疗服务质量产生负面影响，妇女的看法仍然非常积极。本文表明，有组织地实施完全取消用户费用的政策肯定是发展中国家在维持医疗服务质量的同时实现全民覆盖的一种方式。
