The User Fee Introduction and Its Effect in the Health System of Low and Middle Income Countries: An Exploratory Study Using Realist Review Method.
10.4332/KJHPA.2015.25.3.207
- Author:
Kyung Bok SON
1
;
Chang Yup KIM
Author Information
1. Graduate School of Public Health, Seoul National University, Seoul, Korea. cykim@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Realist review;
User fee;
Cost recovery;
CMO configuration
- MeSH:
Consumer Participation;
Fees and Charges*
- From:Health Policy and Management
2015;25(3):207-220
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: The purpose of this exploratory study is to explain where, when and how the introduction of user fee system works in low and middle income countries using context, mechanism, and outcome configuration. METHODS: Considering advanced research in realist review approach, we made a review process including those following 4 steps. They are identifying the review question, initial theory and mechanism, searching and selecting primary studies, and extracting, analyzing, and synthesizing relevant data. RESULTS: User fee had a detrimental effect on medical utilization in low and middle income countries. Also previous and current interventions and community participation were critical context in user fee system. Those contexts were associated with intervention initiation and recognition and coping strategies. Such contexts and mechanisms were critical explanatory factors in medical utilization. CONCLUSION: User fee is a series of interventions that are fragile and dynamic. So the introduction of user fee system needs a comprehensive understanding of previous and new intervention, policy infrastructure, and other factors that can influence on medical utilization.
