title: The impact of vouchers on the use and quality of health care in developing countries: a systematic review.
abstract: One approach to delivering healthcare in developing countries is through voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health care. Using inclusion/exclusion criteria, a search of databases, key journals and websites review was conducted in October 2010. A narrative synthesis approach was taken to summarise and analyse five outcome categories: targeting, utilisation, cost efficiency, quality and health outcomes. Sub-group and sensitivity analyses were also performed. A total of 24 studies evaluating 16 health voucher programmes were identified. The findings from 64 outcome variables indicates: modest evidence that vouchers effectively target specific populations; insufficient evidence to determine whether vouchers deliver healthcare efficiently; robust evidence that vouchers increase utilisation; modest evidence that vouchers improve quality; no evidence that vouchers have an impact on health outcomes; however, this last conclusion was found to be unstable in a sensitivity analysis. The results in the areas of targeting, utilisation and quality indicate that vouchers have a positive effect on health service delivery. The subsequent link that they improve health was found to be unstable from the data analysed; another finding of a positive effect would result in robust evidence. Vouchers are still new and the number of published studies is limiting.
authors: Public Health Program, Touro University California, Mare Island, CA, USA. carinne.brody@gmail.com
authors: Carinne Meyer
authors: CM
authors: Brody
authors: Nicole
authors: N
authors: Bellows
authors: Martha
authors: M
authors: Campbell
authors: Malcom
authors: M
authors: Potts
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006801:Humans; D008389:Marketing of Health Services; D008483:Medical Assistance / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care