Making choices between prepayment and user charges in Zambia : what are the results for equity?
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Kondo, M. & McPake, B. (2007) Making choices between prepayment and user charges in Zambia : what are the results for equity?, Health Economics, vol. 16, , pp. 1371-1387,
In many low-income countries, user charges were introduced in the 1990s. As problems emerged of equity of access, interest grew in developing prepayment mechanisms to protect users from risk of out-of-pocket payments. In Zambia, a prepayment scheme did not generate sufficient revenue, due to abuses of its terms. An alternative scheme using discount cards (a set of coupons to cover episodes of care at discount) was devised. We aimed to understand the equity implications of prepayment and discount cards relative to user charges. We proposed models predicting roles of income, perceived health status, perceived quality of care and time preference in choice of payment mechanism and use of health services. We tested these models using three data sets that could be accessed or collected. It is concluded that relative to user charges, prepayment may facilitate access without incurring income-related equity losses. Evidence concerning discount cards was weaker. We concluded that they facilitate access to a lesser extent. Discount cards offer a credible intermediate solution between user charges and prepayment that avoid some problems associated with prepayment. However, since prepayment seems to be associated with the most positive outcomes, finding other solutions to their problems would be preferred. Copyright 2007 John Wiley & Sons, Ltd.Imagine: There's a boy called Billie who really wants to be a girl. But he's not allowed to show it. And there's a god called Jehovah who's got a wardrobe full of frocks. A closet he's afraid to show anyone. A closet he's locked and thrown away the key. Additional Information: It's begun to strike me, reading the book of GENESIS, that God's hiding something. He's not being straight with us. He's got something hidden in his closet, and tonight we're going to find out what it is... We'll find out through an experiment. An experiment with form. Traditional ideas of what manhood means are bringing war to every continent and endangering all of our lives. It's urgent that we explore different understandings of what it means to be a man; and to do so we need to explore different forms. So myself, the director Lorenzo Mele and the composer Robert Burlin, decided to collaborate to see how far we could get making words work with music, and music work with words. I t's an experiment in another sense too. I've written about 60 plays and seen them through into production. But I've never performed in one of my own. I'm curious to see what happens when I try