The effect of user charge policy and other non price factors on the utilization of health services in dar-es-salaam region, 1994.

Abstract

A cross-sectional study was conducted in Dar-es-Salaam with the objectives of investigating the influence of the introduction of user charges and the effectiveness of the exemption mechanism introduced in public health facilities on utilization of health services. Outpa ient utilization records were analyzed in 3 public

and 3 pri ate hospitals and 242 outpatient interviews were group discussions were conducted to get public done. health workers opinions on the cost-sharing exercise and exemption process. 362 households within the vicinities of the public hospitals were surveyed. The study found that utilization of public facilities declined by 53% between the second and third quarters of 1994 following the introduction of user charges in mid July 1994. The sharp drop could be attributed to demand shifting to lower levels of the public referral system, or to the private sector. Income and cost of care were found to be important factors in influencing choice of health faL:ility. Majority of private users (73%) were paid for by their employer, while \ most public users (70%) paid for themselves. Findings further indicated that 30 % of public users interviewed indicated inability to pay while the proportion exempted was small

ii (3%). This could be due to the lengthy exemption procedure and its inconveniences. The number of years of formal education and the nature of emploYment were found to have a substantial influence on choice of health facility. Public users were less educated and were self employed or unemployed. Closeness to ones' home ~ and quality of care were the-major reasons given for choosing a public or private facility respectively. Age, sex, marital status and household size were not significant factors influencing choice of health facility. It is recommended that the DCC reviews its user charge policy and exemption guidelines, and the local community involved to ensure that the indigent are not denied access to health care.