Studies Link Fee Exemptions and Insurance with Use of Maternal Health Services


Two new HFG reports address one of public health’s most pressing issues: how to reduce maternal and early-childhood mortality in low- and middle-income countries. Specifically, the two papers looked at how insurance enrollment and fee exemptions affected the use and performance of maternal health services. Both reports were published in the December 2013 edition of the Journal of Health, Population and Nutrition.

The first report, “Effect of Health Insurance on the Use and Provision of Maternal Health Services and Maternal and Neonatal Health Outcomes: A Systematic Review” analyzed 29 studies from developing countries around the world. Most of the studies showed a positive correlation between enrollment in an insurance plan and the use of maternal health services. On the other hand, the authors also found several studies in which insurance enrollment was linked to the over-provision of Caesarean section procedures.

The second report, “Effects of User Fee Exemptions on the Provision and Use of Maternal Health Services: A Review of the Literature” studied how the availability and use of maternal health services were affected when out-of-pocket charges for those services were waived. Drawing from 19 published studies, the literature review identified a positive correlation between user fee exemptions and the rate of facility-based births, C-sections, and malaria treatment among pregnant women.  The paper also provided a list of recommendations for policy-makers, including  targeting fee waivers to the poor and ensuring that alternative funding sources are available to compensate for lost fees.

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