In practice, these measures
led to reduced access and equity in health services, mainly because
of the:
- poor working of exemption
mechanisms (leakage of non-exempt groups into free care and groups
meriting exemptions not accessing them due to lack of information,
excessive bureaucratic demands, lack of formal proof of earnings,
etc.);
- reduced use of care in the
poorest groups, associated in some cases with an increase in
damaging health behaviour and in ill health;
- depletion of household assets
to meet health costs, increasing expenditure on future health
risk;
- little improvement in quality
of care at primary care levels, or of increased budget allocations
to these levels;
- insignificant additional revenue
generated;
- weak or temporary impacts
on the use of the referral system without corresponding changes
in quality of care (Equinet
Steering Committee, 1998).
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