title: The elimination of healthcare user fees for children under five substantially alleviates the burden on household expenses in Burkina Faso.
abstract: BACKGROUND
  Since September 2008, an intervention has made it possible to provide free care to children under five in public health facilities in two districts of Burkina Faso. This study evaluated the intervention's impact on household expenses incurred for services (consultations and medications) to the children targeted.
  
  
  METHODS
  The study is based on a survey of a representative panel of 1,260 households encountered in two waves, one month before and 12 months after the introduction of the intervention. The questions explored the illness episodes of all children under five in the 30 days before each wave. The analysis of health expenses incurred during an illness episode distinguished between total expenses and those incurred in public health facilities (charges for services and medications). Analyses based on multilevel simultaneous equation models were used to estimate the probability of spending and the amount spent, in a context where a large number of observations returned a count of zero.
  
  
  RESULTS
  The burden on household expenses was greatly alleviated under the intervention. Average expenditure dropped from US$11 per episode of care to less than US$2 after the intervention was implemented. The risk of incurring an expense at a public health facility was reduced by two-thirds. The facility users' savings were primarily related to medication purchases. In rural areas, where barriers to access health services are more acute, both poor and non-poor families benefited from the intervention. The probability of spending on medications dropped dramatically for both the poor and the non-poor under the exemption (-75% vs.-77%), and the reduction in expenses for medications generated by the intervention was comparable for both groups in relative values (-86% vs.-89%).
  
  
  CONCLUSIONS
  User fees abolition at the point of service substantially alleviated the burden on household expenses. The intervention benefited both poor and non-poor families and provided financial protection.
authors.affiliation: Cellule d'Analyse et de Prospective en Développement (CAPED), Cabinet du Premier Ministre, République du Niger, 28, Avenue du Mounio, BP 13.568, Niamey, Niger. abdouillou@yahoo.ca.
authors.forename: Mahaman Mourtala
authors.initials: MM
authors.lastname: Abdou Illou
authors.affiliation: Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Canada. slim.haddad@fmed.ulaval.ca.|Centre de recherche du CHU de Québec, 1050 chemin de Ste-Foy, Québec, QC, G1S-4L8, Canada. slim.haddad@fmed.ulaval.ca.
authors.forename: Slim
authors.initials: S
authors.lastname: Haddad
authors.affiliation: University of Montreal Hospital Research Centre (CRCHUM), Saint-Antoine Tower, 850 Saint-Denis St., Montreal, QC, H2X 0A9, Canada. isabelleagier@gmail.com.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Agier
authors.affiliation: University of Montreal Hospital Research Centre (CRCHUM), Saint-Antoine Tower, 850 Saint-Denis St., Montreal, QC, H2X 0A9, Canada. valery.ridde@umontreal.ca.
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
mesh_terms: D002050:Burkina Faso; D002675:Child, Preschool; D017281:Cost of Illness; D005191:Family Characteristics; D005249:Fees and Charges; D005260:Female; D005102:Health Expenditures; D006291:Health Policy; D006296:Health Services / Q000191:economics; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male