title: User fees, health staff incentives, and service utilization in Kabarole District, Uganda.
abstract: OBJECTIVE
  To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District, western Uganda.
  
  
  METHODS
  Of the 38 government health units that had introduced user-fee financing schemes, 11 were included in the study. Outpatient utilization was assessed as the median number of visits per month before and after cost sharing began.
  
  
  RESULTS
  After the introduction of cost sharing, overall utilization of general outpatient services, assessed by combining the data from all the participating units, dropped by 21.3%. Utilization increased, however, in facilities located in remote areas, while it decreased in those located in urban or semi-urban areas. The increased utilization in remote facilities was considered to be largely attributable to health workers' incentive payments derived from cost-sharing revenues.
  
  
  CONCLUSIONS
  Incentive payments led the health workers to offer improved services. Other factors may also have been influential, such as an improved drug supply to health facilities and increased public identification with community projects in remote areas.
authors.affiliation: Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. walter.kipp@ualberta.ca
authors.forename: W
authors.initials: W
authors.lastname: Kipp
authors.forename: J
authors.initials: J
authors.lastname: Kamugisha
authors.forename: P
authors.initials: P
authors.lastname: Jacobs
authors.forename: G
authors.initials: G
authors.lastname: Burnham
authors.forename: T
authors.initials: T
authors.lastname: Rubaale
mesh_terms: D001291:Attitude of Health Personnel; D003151:Community Health Centers / Q000191:economics / Q000706:statistics & numerical data*; D017047:Cost Sharing; D004649:Employee Incentive Plans; D005249:Fees and Charges; D006078:Government Programs; D019538:Health Care Surveys; D006282:Health Personnel / Q000191:economics / Q000523:psychology; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D012424:Rural Population; D014454:Uganda; D014505:Urban Population; D014600:Utilization Review