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

dc.contributor.authorWiysonge, Charles S.en_ZA
dc.contributor.authorPaulsen, Elizabethen_ZA
dc.contributor.authorLewin, Simonen_ZA
dc.contributor.authorCiapponi, Agustinen_ZA
dc.contributor.authorHerrera, Cristian A.en_ZA
dc.contributor.authorOpiyo, Newtonen_ZA
dc.contributor.authorPantoja, Tomasen_ZA
dc.contributor.authorRada, Gabrielen_ZA
dc.contributor.authorOxman, Andrew D.en_ZA
dc.date.accessioned2018-08-08T10:42:38Z
dc.date.available2018-08-08T10:42:38Z
dc.date.issued2017
dc.descriptionCITATION: Wiysonge, C. S., et al. 2017. Financial arrangements for health systems in low-income countries : an overview of systematic reviews. Cochrane Database of Systematic Reviews, 9:1-74, Art. CD011084, doi:10.1002/14651858.CD011084.pub2.
dc.descriptionThe original publication is available at https://www.cochranelibrary.com
dc.description.abstractBackground: One target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health‐care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low‐income countries. Objectives: To provide an overview of the evidence from up‐to‐date systematic reviews about the effects of financial arrangements for health systems in low‐income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on financial arrangements, and informing refinements in the framework for financial arrangements presented in the overview. Methods: We searched Health Systems Evidence in November 2010 and PDQ‐Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language, or publication status limitations in the searches. We included well‐conducted systematic reviews of studies that assessed the effects of financial arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment, or financial burden of patients, e.g. out‐of‐pocket payment, catastrophic disease expenditure) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low‐income countries. Main results: We identified 7272 reviews and included 15 in this overview, on: collection of funds (2 reviews), insurance schemes (1 review), purchasing of services (1 review), recipient incentives (6 reviews), and provider incentives (5 reviews). The reviews were published between 2008 and 2015; focused on 13 subcategories; and reported results from 276 studies: 115 (42%) randomised trials, 11 (4%) non‐randomised trials, 23 (8%) controlled before‐after studies, 51 (19%) interrupted time series, 9 (3%) repeated measures, and 67 (24%) other non‐randomised studies. Forty‐three per cent (119/276) of the studies included in the reviews took place in low‐ and middle‐income countries.en_ZA
dc.description.urihttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011084.pub2
dc.description.versionPublisher's version
dc.format.extent76 pages
dc.identifier.citationWiysonge, C. S., et al. 2017. Financial arrangements for health systems in low-income countries : an overview of systematic reviews. Cochrane Database of Systematic Reviews, 9:1-74, Art. CD011084, doi:10.1002/14651858.CD011084.pub2
dc.identifier.issn1469-493X (online)
dc.identifier.otherdoi:10.1002/14651858.CD011084.pub2
dc.identifier.urihttp://hdl.handle.net/10019.1/104243
dc.language.isoen_ZAen_ZA
dc.publisherJohn Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration
dc.rights.holderAuthors retain copyright
dc.subjectMedical care -- Needs assessmenten_ZA
dc.titleFinancial arrangements for health systems in low-income countries : an overview of systematic reviewsen_ZA
dc.typeArticleen_ZA
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