Cost recovery for drugs provided at the rural dispensary: an experiment in Niger.

T Juncker
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Abstract

An intervention was conducted in 1989-1990 in rural Niger to introduce a cost recovery system for the drugs prescribed at the dispensary level. The community concerned, about 27,000 persons, chose to pay a fixed fee per episode of illness. The fee covered the treatment for a maximum of seven days. The rate was fixed at US$ 0.8 per adult and US$ 0.4 per child. The drug prescription was rationalized through decisional guidelines including standardized treatments with essential drugs. All drugs were bought locally but most of them were commercial brands. During the first ten months of intervention, the revenues only covered 51% of the drug expenses. Aware of the deficit, the village representatives decided to double the fees. As a consequence, the cost recovery rate reached 77%. During the low fee period, the utilization of the curative services increased by 80%. When the fees were doubled, the attendance steadily declined and tended to reach the rate registered before the intervention while the mean cost per case and the percentage of costly treatments with antibiotics increased. It can be assumed that the increase in fees deterred patients requiring low-cost treatment.

农村药房提供药品的成本回收:尼日尔的一项实验。
1989-1990年在尼日尔农村进行了一项干预措施,为药房一级开出的药物实行费用回收制度。有关社区约有27,000人选择按每次发病支付固定费用。这笔费用包括最多7天的治疗费用。费率固定为每位成人0.8美元,每位儿童0.4美元。通过包括基本药物标准化治疗在内的决策指导方针,使药物处方合理化。所有药物均为本地购买,但大部分为商业品牌。在干预的前10个月,收入只覆盖了药品费用的51%。意识到赤字后,村代表决定将费用提高一倍。因此,成本回收率达到77%。在低收费期间,治疗服务的利用率增加了80%。当费用增加一倍时,出勤率稳步下降,并趋于达到干预前的登记率,而每个病例的平均费用和昂贵的抗生素治疗百分比增加。可以假设,费用的增加阻止了需要低成本治疗的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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