@article{Hone:2017:heapol/czw178,
author = {Hone, T and Lee, JT and Majeed, A and Conteh, L and Millett, C},
doi = {heapol/czw178},
journal = {Health Policy and Planning},
pages = {723--731},
title = {Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review.},
url = {http://dx.doi.org/10.1093/heapol/czw178},
volume = {32},
year = {2017}
}

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TY  - JOUR
AB  - Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients.
AU  - Hone,T
AU  - Lee,JT
AU  - Majeed,A
AU  - Conteh,L
AU  - Millett,C
DO  - heapol/czw178
EP  - 731
PY  - 2017///
SN  - 1460-2237
SP  - 723
TI  - Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review.
T2  - Health Policy and Planning
UR  - http://dx.doi.org/10.1093/heapol/czw178
UR  - http://www.ncbi.nlm.nih.gov/pubmed/28453713
UR  - http://hdl.handle.net/10044/1/45116
VL  - 32
ER  - 

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