Cost recovery and improved drug availability in Niger--implications for total patient treatment costs

Using quasi-experimental design methods, this study investigated, for a cost recovery intervention in Niger, how the total costs of an episode of treatment for an acute illness for a typical patient changed when user fees were imposed but accompanied by an improved drug supply. Episode costs included both cash and opportunity costs. With few exceptions, the comparisons of both the unadjusted and adjusted patient episode costs showed that patient total episode costs in the intervention sites increased relative to the control site. The infusion of resources in Say and Boboye meant that now patients had essential medicines to buy, in comparison to Illela where stocks of essential medicines continued to deteriorate. Trends in episode costs within each intervention district demonstrated that to some extent cost recovery accompanied by an improved drug supply did not significantly change the total cost of an episode of treatment. In Say, this was true for malaria cases, females and the poor. However, in Boboye, reductions in copayments were offset by a mandatory tax payment paid by both users and non-users.