Analysis of the user fee for health care policy in Eritrea.
OBJECTIVE
To assess the macro-context of the user fee policy design and implementation; to critically evaluate the content of the user free policy with respect to its implications for efficiency, equity, quality and utilisation of health care and to scrutinize the implementation of the scheme and identify the successes and problems encountered since the introduction of the user fee policy in 1996.


METHODS
Cross sectional.


METHODS
Mekane Hiwot Central Referral Hospital and Semenawi Asmore Health Centre.


METHODS
50 health professionals and support staff; 150 outpatients of which 100 patients were from the hospital and 50 from the health centre and 50 inpatients from the hospital.


METHODS
Service utilisation.


RESULTS
The policy was launched against a conducive macro-economic, political and health sector background. Fees reduced attendance at the tertiary referral hospital and reversed the previous trend of sharply declining use of primary level facilities. However, the fee levels could not give an adequate signal to patients to use the appropriate cost effective levels of care and the referral system. The cost recovery ratio for the system as a whole was found to be one of the highest in sub-Saharan Africa. At some of the lowest levels of the health care system, however, the scheme does not seem viable. Fee waivers were infrequent, and the process of means testing was lengthy, thus adversely affecting equity.


CONCLUSIONS
The new policy resulted in a cost recovery ratio. There was some indication of allocative efficiency achievement as a result of the price signals. The policy required some refinement in terms of expanding the exemption categories and revenue retention at the facility level.
Asbu
E Z
EZ
Department of Community Health, University of Cape Town, Observatory 7925, South Africa. asbeyo01@southone.uct.ac.za
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D019017:Eritrea; D005249:Fees and Charges; D006291:Health Policy / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data*; D015980:Public Health Practice / Q000191:economics* / Q000592:standards; D011787:Quality of Health Care