보건행정학회지 (Health Policy and Management)

  • 제25권3호
  • /
  • Pages.207-220
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  • 2015
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  • 1225-4266(pISSN)
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  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
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중·저소득 국가의 건강보장제도에서 이용자 부담 도입과 효과: Realist Review 방법을 활용한 탐색적 연구

The User Fee Introduction and Its Effect in the Health System of Low and Middle Income Countries: An Exploratory Study Using Realist Review Method

  • Son, Kyung Bok (Graduate School of Public Health, Seoul National University) ;
  • Kim, Chang-Yup (Graduate School of Public Health, Seoul National University)
  • 투고 : 2015.07.18
  • 심사 : 2015.09.24
  • 발행 : 2015.09.30
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초록

Background: The purpose of this exploratory study is to explain where, when and how the introduction of user fee system works in low and middle income countries using context, mechanism, and outcome configuration. Methods: Considering advanced research in realist review approach, we made a review process including those following 4 steps. They are identifying the review question, initial theory and mechanism, searching and selecting primary studies, and extracting, analyzing, and synthesizing relevant data. Results: User fee had a detrimental effect on medical utilization in low and middle income countries. Also previous and current interventions and community participation were critical context in user fee system. Those contexts were associated with intervention initiation and recognition and coping strategies. Such contexts and mechanisms were critical explanatory factors in medical utilization. Conclusion: User fee is a series of interventions that are fragile and dynamic. So the introduction of user fee system needs a comprehensive understanding of previous and new intervention, policy infrastructure, and other factors that can influence on medical utilization.

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