User-Fees in Health Services: Assessing how it Impacts on Access, Utilization and Quality of Care in a Tertiary Health Facility in Delta State, Nigeria

摘要

Objective: To assess how user-fees policy impacts on clienteles’ access to care, willingness to utilize health services and their satisfaction with the quality of healthcare, having to pay at the point of service in a tertiary health facility. Method: This was a cross-sectional descriptive study. The instrument was a pre-tested, semi-structured self administered questionnaire. Descriptive statistics as well as chi-square test and regression analysis were done to show statistically significant associations. Results: The findings reveal different modes money was made available for payment for health services. On the whole, about 98% of payment were through ‘formal’ out-of pocket spending (user-fees) with most respondents having to source for funds from own money. It was shown that user-fees increases ‘rational’ demand for services and at the same time decreasing the willingness to seek such level of care. However, it is associated with better quality service delivery. Conclusion: The findings from this study has brought to the fore that user-fee policy is an effective mechanism for achieving desired health outcomes in tertiary care. However, there remain the problems of inequities in tertiary healthcare coverage. The evidence so far suggests that user fees alone will not accomplish the sustainability objectives in health financing in the country. This suggests that charges levied for tertiary health services should therefore be linked to the broader package of financing through health insurance coverage.