The impact of vouchers on the use and quality of health care in developing countries: A systematic review

Abstract

One approach to delivering healthcare in developing countries is through voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health care. Using inclusion/exclusion criteria, a search of databases, key journals and websites review was conducted in October 2010. A narrative synthesis approach was taken to summarise and analyse five outcome categories: targeting, utilisation, cost efficiency, quality and health outcomes. Sub-group and sensitivity analyses were also performed. A total of 24 studies evaluating 16 health voucher programmes were identified. The findings from 64 outcome variables indicates: modest evidence that vouchers effectively target specific populations; insufficient evidence to determine whether vouchers deliver healthcare efficiently; robust evidence that vouchers increase utilisation; modest evidence that vouchers improve quality; no evidence that vouchers have an impact on health outcomes; however, this last conclusion was found to be unstable in a sensitivity analysis. The results in the areas of targeting, utilisation and quality indicate that vouchers have a positive effect on health service delivery. The subsequent link that they improve health was found to be unstable from the data analysed; another finding of a positive effect would result in robust evidence. Vouchers are still new and the number of published studies is limiting.

Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia

“…Vouchers have been introduced in Bangladesh, [1][2][3] China, India, 4 Indonesia, Kenya, 5,6 Pakistan 7 and Uganda and have been associated with increased utilization of maternal health care. 8,9 However, since other interventions have been implemented at the same time, one cannot be sure that the increase is attributable to vouchers alone. Given the presence of alternative interventions that can influence the demand for, and supply of, maternal health care, 10 it is important to have evidence that voucher schemes of varying designs can be effective in different geographical and cultural contexts.…”

“…Unlike the voucher schemes operating in most other countries, 9,12 those in Cambodia do not cover a range of providers but are, instead, restricted to subsidizing maternity care at public facilities, mainly health centres. As such, the vouchers function as fee waivers.…”

Financial arrangements for health systems in low-income countries: an overview of systematic reviews

“…Four reviews included studies from a mix of low-, middle- and high-income countries (Akbari 2008; Haynes 2008; Brody 2013; Lutge 2015) .One review did not have any included studies (Rutebemberwa 2014). …”

Horizontal Inequities In The Uptake Of Hospital Delivery And The Role Of Social Determinants In China

“…Therefore care specific demand side finance may be more effective than wide social protection programs. For that targeted demand side finance approaches like delivery vouchers [30,31] , delivery fee exemptions [32], and conditional cash transfers [33] are all possible effective policy alternatives, with the last two approaches probably more effective, as proposed by the diagonal health system strengthening approach [34]. Meanwhile, the results also sheds light that it is the ability to pay rather than Total -0.110 37.70 59.86 100.00 -0.055 0.00 0.00 100.00 [39].…”