There are several policy implications for these results Sinc

There are several policy implications for these results. Since 2006 in an attempt to reduce financial barriers, delivery care has been exempt from user fees in Burkina Faso (Ridde, Richard, Bicaba, Queuille, & Conombo, 2011). While user fee reductions have been shown to increase service coverage, many women continued to deliver at home demonstrating that cost was not the only barrier to care seeking (De Allegri, Tiendrebéogo, Müller, Yé, Jahn & Ridde, 2015; Ganaba et al., 2016). This study shows that in the context of user fee reductions, additional strategies that focus on reinforcing the delivery of essential health services, such as performance-based financing, might be a successful policy tool to further increase coverage by increasing health worker motivation while ensuring quality of care. PBF in Burkina Faso has a relatively low cost for implementation, with an average cost of US$3.00 per capita per year to target the entire package of services at the primary and secondary levels of care. Given the positive results observed during the pre-pilot cyclin dependent kinases and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health. In-depth cost-benefit analyses of different policies should be conducted to compare the impact of these interventions relative to their cost. Additionally, research investigating how to better target the poor, and how to solve demand side challenges within PBF program approach would be valuable.
Conclusion
Funding This work was supported by the World Bank through the Health Results Innovation Trust Fund (HRITF).
Conflict of interest statement
Introduction The United States spent $3.2 trillion or $9990 per person on healthcare in 2015 (Centers for Medicare and Medicaid Services, 2015b) and ranks first in the world for per-capita healthcare spending, which is more than double the average within the Organization for Economic Cooperation and Development (OECD) (Organisation for Economic Co-operation and Development, 2015). Despite this elevated level of healthcare spending, Americans have both shorter life expectancy and poorer health than residents in most other OECD countries (Avendano & Kawachi, 2014; Bezruchka, 2012; National Research Council and Institute of Medicine, 2013). This US health disadvantage has been attributed to a number of cross-country differences, but differences in prices and administrative inefficiencies are major drivers of the excess costs in the US system that are also under policy control. A recent report in The New York Times (Rosenthal, Lu, & Cram, 2013) took note of sharply discordant prices for standard healthcare services in the US compared to other countries. An MRI scan whose cost averages $319 in the Netherlands costs three times that amount in the US; a hip replacement that averages $8000 in Spain costs quintuple that amount in the US; and a dose of Lipitor that averages $6 in New Zealand costs 12 times as much in the US. These examples may be extreme, but they are hardly unique or marginal. The US pays a much higher cost per service delivered than any other developed country (Squires, 2012). In a New England Journal of Medicine commentary, two well-known health economists have pointed out that simply standardizing insurance products could reduce administrative hassles, resulting in savings of $200 billion annually (Fuchs & Milstein, 2011). A report from the Institute of Medicine (Young & Olsen, 2010) estimated $425 billion a year in excessive costs-per-service delivered, including $130 billion in inefficiently delivered services, $190 billion in excessive administrative costs, and $105 billion in prices that are too high (2009 dollars). Urgent and well-argued calls have been issues for the public health community to engage in a more informed debate about how best to allocate resources to achieve health for all (McDonough, 2016). Important observations are that a much higher fraction of public spending is on healthcare in the US than in peer countries, that a much smaller fraction is on public health and social spending, and that the US lies beyond what economists call “the flat of the curve,” the area at which additional spending on healthcare has little value, and may actually be harmful. Why do these problems persist when they seem so clearly harmful?