@article{fdi:010075535,
  title = {{O}ut-of-pocket payments in the context of a free maternal health care policy in {B}urkina {F}aso : a national cross-sectional survey},
  author = {{M}eda, {I}. {B}. and {B}aguiya, {A}. and {R}idde, {V}al{\'e}ry and {O}uedraogo, {H}. {G}. and {D}umont, {A}lexandre and {K}ouanda, {S}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground{I}n {A}pril 2016, {B}urkina {F}aso introduced a free health care policy for women. {I}nstead of reimbursing health facilities, as many sub-{S}aharan countries do, the government paid them prospectively for covered services to avoid reimbursement delays, which are cited as a reason for the persistence of out-of-pocket ({OOP}) payments. {T}his study aimed to (i) estimate the direct expenditures of deliveries and covered obstetric care, (ii) determine the {OOP} payments, and (iii) identify the patient and health facility characteristics associated with {OOP} payments.{M}ethods{A} national cross-sectional study was conducted in {S}eptember and {O}ctober 2016 in 395 randomly selected health facilities. {A} structured questionnaire was administered to women (n=593) who had delivered or received obstetric care on the day of the survey. {T}he direct health expenditures included fees for consultations, prescriptions, paraclinical examinations, hospitalization and ambulance transport. {A} two-part model with robust variances was performed to identify the factors associated with {OOP} payments.{R}esults{A} total of 587 women were included in the analysis. {T}he median direct health expenses were {US}$5.38 [interquartile range ({IQR}):4.35-6.65], {US}$24.72 [{IQR}:16.57-46.09] and {US}$136.39 [{IQR}: 108.36-161.42] for normal delivery, dystocia and cesarean section, respectively. {N}early one-third (29.6%, n=174) of the women reported having paid for their care. {OOP} payments ranged from {US}$0.08 to {US}$98.67, with a median of {US}$1.77 [{IQR}:0.83-7.08]). {O}verall, 17.5% (n=103) of the women had purchased drugs at private pharmacies, and 11.4% (n=67) had purchased cleaning products for a room or equipment. {OOP} payments were more frequent with age, for emergency obstetric care and among women who work. {T}he women's health region of origin was also significantly associated with {OOP} payments. {F}or those who made {OOP} payments, the amounts paid decreased with age but were higher in urban areas, in hospitals, and among the most educated women. {T}he amounts paid were lower among students and were associated with health region.{C}onclusion{T}he policy is effective for financial protection. {H}owever, improvements in the management and supply system of health facilities' pharmacies could further reduce {OOP} payments in the context of the free health care policy in {B}urkina {F}aso.},
  keywords = {{F}ree care policy ; {M}aternal care ; {D}irect expenses ; {O}ut-of-pocket payment ; {S}ub-{S}aharan ; {BURKINA} {FASO} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{H}ealth {E}conomics {R}eview},
  volume = {9},
  numero = {},
  pages = {art. 11 [14 ]},
  ISSN = {2191-1991},
  year = {2019},
  DOI = {10.1186/s13561-019-0228-8},
  URL = {https://www.documentation.ird.fr/hor/fdi:010075535},
}