Search Results (73)

Background: Community-based health insurance is an important strategy for extending healthcare access and financial protection to informal-sector populations. In Tanzania, the Improved Community Health Fund (iCHF) is implemented through region-specific models that differ in benefit packages, premium arrangements, and provider participation. However, evidence on how members experience these different implementation models remains limited. This study compared members’ experiences and perceptions of CHF implementation in Dodoma and Kilimanjaro, two regions operating different iCHF models. Methods: The study used data from a cross-sectional household survey conducted among 420 CHF-enrolled members in Dodoma and Kilimanjaro in January 2018. Data were collected using a structured, interviewer-administered household questionnaire covering socio-demographic characteristics, CHF enrolment history, registration and premium-payment experiences, benefit-package perceptions, trust in CHF management and community participation, perceived healthcare service quality, and perceived benefits of membership. Data were analyzed using descriptive statistics, cross-tabulations, and Pearson’s chi-square tests to assess regional differences. Results: Members generally reported positive experiences with CHF administration. Most had used their CHF cards, renewal intentions were high, premiums were considered affordable, payment arrangements were convenient, and local CHF management was generally perceived as trustworthy. Statistically significant regional differences were observed in renewal intention, satisfaction with CHF officers, perceived healthcare service quality, and perceived household benefit (p < 0.05). Dodoma respondents reported higher renewal intention and a higher proportion of households benefiting from CHF. The distribution of healthcare-quality ratings also differed significantly (p < 0.001): Kilimanjaro had a higher proportion rating care as excellent (16.1% vs. 2.9%), whereas Dodoma had a higher proportion rating care as good (44.6% vs. 38.9%). Challenges in both regions included limited benefit coverage, additional out-of-pocket payments, long waiting times, and limited perceived advantages of CHF membership. Conclusions: Regional differences were observed in members’ experiences; however, because the regional samples differed socioeconomically and the analysis was not adjusted for potential confounders, these differences should not be attributed to the iCHF models themselves. The findings describe members’ experiences during the 2018 pilot period and should not be interpreted as a direct description of current iCHF performance. The results nevertheless highlight the importance of benefit coverage, service responsiveness, financial protection, and healthcare quality alongside efficient administration. Full article

Background and Objectives: Pain has been proposed as a pathway linking chronic disease to healthcare spending, but existing estimates measure exposure, pain and cost in the same period and combine coefficients on incompatible scales. We asked how much of the disease–expenditure association runs through pain when exposure, pain and cost are separated in time. Materials and Methods: In the Korea Health Panel Survey (2019–2023; 54,845 adult person-years), chronic disease at year t, EQ-5D pain/discomfort at t + 1 and out-of-pocket payments during t + 2 were linked, conditioning on pain and payments at t. Direct and indirect effects were estimated by parametric g-computation (randomised-interventional analogues, two-part outcome model, exposure-specific adjustment sets, survey and censoring weights, false discovery rate control). Results: Among 25,692 triplets, pain/discomfort predicted the amount spent among healthcare users (cost ratio, CR 1.099, 95% confidence interval, CI 1.023–1.180) but showed no detectable association with whether care was used (odds ratio, OR 1.136, 0.918–1.406); the contemporaneous cost ratio was substantially larger (1.296), inflated by simultaneity. Three musculoskeletal conditions prospectively predicted pain (false discovery rate q < 0.001). Six conditions had indirect-effect intervals excluding zero, but none survived false discovery rate correction (minimum q = 0.19); where estimable, the proportion mediated was small (2.8% to 4.8%). Conclusions: The disease → pain and pain → payment associations are each established, but the disease-specific mediated amount is not confirmed after multiplicity correction. Contemporaneous designs overstate the indirect association; claims that pain causes a specified share of chronic disease expenditure are not supported. Full article

Background/Objectives: Standardised institutional patient satisfaction surveys are the primary quality-monitoring tool in Romanian public hospitals, but their ability to capture the full range of patient experiences remains uncertain. This study quantifies the discrepancy between institutional patient satisfaction scores and an independent, unmediated national feedback instrument, the Patient Feedback Mechanism (MFP), at Targoviste County Emergency Hospital (SJUT) over a six-year period (2019–2024), and examines item-level MFP results across eight dimensions of the patient experience, including dimensions not captured by the institutional indicators routinely reported by SMCSP. Methods: A sequential design combined six years of institutional satisfaction data (2019–2024) from SJUT (N = 32,176 questionnaires) with item-level MFP results for the same period, covering eight questions on medical services, cleanliness, out-of-pocket medication costs, staff involvement, communication, recommendation intent, self-reported health outcome, and willingness to report requests for money from staff. Hypotheses were tested using two-proportion z-tests with Wilson confidence intervals, Mann–Kendall trend analysis, and Cohen’s h for effect sizes. Results: Institutional satisfaction remained consistently high (96.88–97.45%), while MFP satisfaction with medical services ranged from 70.7% to 88.9% across the same years, yielding gaps of 7.9 to 26.7 percentage points, significant in every year (p < 0.001; Cohen’s h ranging from 0.32 to 0.82). The gap did not follow a monotonic trend (Mann–Kendall p = 0.469); instead, it widened to a peak in 2021 and narrowed progressively through 2024. A parallel comparison between the Quality and Patient Safety Management Service (SMCSP) overall impression item (exceeding 99%) and the MFP recommendation item (69.9–76.3%) showed even larger gaps, of 23.3 to 29.6 percentage points. The MFP item on willingness to report requests for money from staff, which is not part of SMCSP’s reported institutional indicators, remained in a narrow 4.0–5.5% range between 2019 and 2023 with no significant trend (Mann–Kendall p = 0.82); a higher 2024 value (6.9%) coincides with a national redesign of this item and is not directly comparable to earlier years. Conclusions: Institutional surveys and an independent national feedback instrument offer structurally distinct perspectives on hospital performance, reflecting differences in administration rather than equivalent estimates of patient satisfaction. The discrepancy between sources is significant and persistent, though not monotonic, widening sharply during 2021 before narrowing. One item with no institutional equivalent documents a measurable, non-trivial proportion of patients willing to report informal payment requests every year, although the available data do not establish whether this proportion is rising over time. Systematic use of existing MFP data, already collected nationally, can complement institutional surveys at minimal additional cost, provided the two instruments are interpreted as structurally different rather than as alternative estimates of the same quantity. Full article

Oral health problems among older adults represent a growing public health concern due to increasing life expectancy and treatment needs. This study aimed to assess dental treatment needs and cost burden within the context of oral health policies. This retrospective study included anonymized data from 250 patients aged ≥65 years (F/M: 121/129; 65–89 years). Sociodemographic characteristics, treatment needs, and costs were obtained from the Hospital Information Management System (HIMS). Costs were adjusted to 2025 Turkish lira values using the Consumer Price Index and converted to international dollars using purchasing power parity (PPP). Patients were classified by total treatment costs using K-means cluster analysis. Periodontal (61.2%), restorative (36.0%), and endodontic (41.2%) treatment needs, which are largely preventable through oral hygiene practices, were more frequent among patients with a lower mean age, whereas tooth loss and prosthodontic treatment needs (89.6%) increased with mean age. Cluster analysis identified two groups: a low-cost group (67.6%) and a high-cost group (32.4%). The high-cost group had a lower mean age (68.84 ± 4.27 years) compared to the low-cost group (70.73 ± 5.18 years), indicating that relatively younger patients needed more complex and costly treatments. Out-of-pocket payments were notable for prosthodontic and surgical treatments, although Social Security Institution (SSI) payments constituted most of the costs. Preventive and early dental care strategies are essential to reduce treatment complexity and cost burden among older adults within the framework of oral health policy. Full article

Introduction: Musculoskeletal conditions impose a substantial economic burden on the United States (U.S.) healthcare system, but contemporary national estimates of condition-specific spending for common orthopaedic conditions remain limited. This study utilized the 2023 Medical Expenditure Panel Survey (MEPS) to estimate the national prevalence, condition-specific expenditures, and payer distribution for treated knee injuries and shoulder disorders. Methods: Adults with treated knee injuries or shoulder disorders were identified using ICD-10-CM codes from the MEPS Medical Conditions File. Condition-specific expenditures were estimated by linking diagnoses to medical events and payments using the MEPS Condition–Event Link File. Expenditures were aggregated across inpatient, outpatient, office-based, emergency, home health, and prescribed medicine categories. Survey-weighted analyses were used to estimate national prevalence, mean expenditures, service-level spending patterns, and payer distributions. Survey-weighted Gamma generalized linear models with log link were used to examine patient characteristics associated with expenditures among the U.S. civilian noninstitutionalized population with positive condition-specific spending. Results: The analysis identified 2.55 million adults with treated knee injuries and 2.58 million adults with treated shoulder disorders. Mean annual condition-specific expenditures per person were higher for knee injuries ($10,552; 95% CI: $6128–$14,975) than for shoulder disorders ($4310; 95% CI: $3337–$5283). Knee injury expenditures were concentrated in inpatient and home health care, whereas shoulder disorder expenditures were concentrated in outpatient and office-based care. Private insurance, Medicare, out-of-pocket payments, and Worker’s Compensation each contributed to the financial burden, with payer distributions varying by condition. In adjusted models, fair/poor self-rated health and female sex were associated with higher knee injury expenditures, while no covariates were statistically significant for shoulder disorder expenditures. Conclusions: Treated knee injuries and shoulder disorders showed distinct condition-specific expenditure profiles across care settings and payer sources. These findings provide contemporary national benchmarks for orthopaedic spending and may support future research, utilization monitoring, and value-based reimbursement planning. Full article

Background: Vestibular tests are critical for an early detection of balance disorders, thereby reducing the risk of falls, particularly in older adults. The present is an ecologic study where the units of observation are the Italian Regions. Regional scores of access to essential levels of care (LEAs) were employed as predictors to investigate the hypothesis that vestibular examinations supplied by the Italian National Health Service (NHS) were insufficient to meet the needs of the Italian population. Methods: The number of first-level (clinical evaluations of vestibular function) and second-level (recorded spontaneous nystagmus, induced nystagmus, or rotary stimulation) vestibular tests per 100 K population was estimated by Italian region and calendar year during the 2021–2023 period. The odds (i.e., number of any second-level vestibular tests divided by difference between number of first- and second-level tests) by region and calendar year were investigated as a proxy for regional propensity to refer patients to a second-level test following a first-level vestibular assessment. A logistic regression investigated the odds by region and calendar year. Lastly, the regional number × 100 K population (prevalence) of vestibular examinations underwent linear regression analysis, using LEAs as predictors. Results: Descriptive analysis showed that first-level assessments were the most common vestibular tests in Italy during the 2021–2023 period. Prevalence of first-level vestibular examinations was not associated with any indicator of access to healthcare in linear regression. By contrast, the prevalence of second-level vestibular tests decreased with social inequality yet increased with the indicator of higher access to hospital care. In logistic regression, referral propensity to second-level vestibular tests progressively decreased from 2021 to 2023 and exhibited considerable regional variability, being lower than in Lombardy (reference) in all other Italian regions but Veneto (aOR = 4.826; 95%CI: 4.445; 5.329) and Trento autonomous province (aOR = 1.488; 1.363; 1.624). Conclusions: The number of vestibular function tests supplied by the National Health Service in Italy during the 2021–2023 period was probably insufficient to meet the care needs of the general population, forcing more than 66.8% of patients to forgo vestibular evaluation or turn to private audiological services with out-of-pocket payments. The shortfall was greater for more costly instrumental (second-level) vestibular tests, whose supply was influenced by social inequalities and barriers to accessing audiology care at the regional level. The National Recovery and Resiliency Plan has allocated EUR 20.23 billion for healthcare services in Italy, with the aim of addressing patient care requirements in every area of the country. Full article

Background/Objectives: Health system socio-economic inequities in dental care are a long-standing problem in Europe. The issue gained increased relevance during the recent pandemic due to service disruption and socio-economic inequities that become even more pronounced under such circumstances. However, while preventive dental programs are considered key elements of public health, little is known about their role in addressing equity in accessing dental care among different countries and over time between them. This research aims at investigating the relationship between preventive dental policy, socio-economic factors, and the inability to get appropriate dental care within EU member states. Methods: A longitudinal panel dataset at the country level, consisting of data collected during 2020 through 2024, was assembled using open sources of statistics from Europe and other international statistical databases. The dependent variable used in the study was the percentage of the population that had unmet dental care need because of cost. Independent variables were the presence or absence of preventive policies related to dentistry, educational attainment, gross domestic product per capita, unemployment rate, number of dentists, and out-of-pocket expenses. Balanced panel datasets and regressions with robust standard errors in random-effects models were estimated. Interaction terms were created to test the moderating effect of education level on the relationship between policies and access to care. Results: Cross-country variations in terms of the prevention policy environment, socio-economic status, and unmet dental care need were found from descriptive analysis. The higher level of out-of-pocket payment was always related to the higher unmet dental care need, while the lower GDP countries displayed poorer access. Using the balanced panel random-effects model, preventive dental policies and the interaction between preventive policies and educational level were insignificant factors predicting the unmet dental care need. On the other hand, higher out-of-pocket payments, education, and dentists per million population had nearly significant positive relationships. In the sensitivity analysis, GDP per capita showed a negative association, whereas dentists per million population remained positively associated with unmet dental care need. Conclusions: The findings suggest that inequalities in access to dental care during and after the COVID-19 period were shaped primarily by financial and structural determinants rather than by the presence of preventive policies alone. While preventive programs remain an important component of long-term oral health strategies, reducing direct household payment burden and strengthening health system capacity may represent more immediate mechanisms for maintaining equitable access to dental services during periods of system disruption. Full article

An updated understanding of the U.S. oral health care system is essential for addressing the burden of oral disease, high dental expenditures, and persistent inequities in access. This narrative review synthesizes current evidence on the prevalence of major oral diseases, dental care delivery, financing, dental workforce, and public health initiatives, and highlights the challenges and future opportunities in the U.S. A comprehensive search of PubMed, Google Scholar, and reports from U.S. federal agencies and professional organizations was conducted between September 2025 and March 2026. Following the latest National Health and Nutrition Examination Survey, untreated caries remains widespread, affecting 11% of children (ages 2–5), 10% of adolescents (ages 12–19), 21% of adults (ages 35–49), and 12% of older adults (ages 65–74). Periodontal diseases are common, with 42% of adults aged 30 years or older having periodontitis. Oral cancer incidence stands at 11.5 per 100,000 and increases sharply with advancing age. Edentulism among older adults (ages 65–74) was approximately 11%. The U.S. dental workforce includes over 200,000 dentists, yet shortages affect rural and low-income areas, with 62 million Americans living in Dental Health Professional Shortage Areas. Dental care is primarily delivered through private practices, supplemented by community health centers. Financing relies mostly on private insurance and out-of-pocket payments, while the coverage of public programs like Medicaid varies across states, and Medicare generally excludes routine dental care for older adults. Water fluoridation remains widespread, yet ongoing debates highlight persistent challenges. School-based dental sealants and topical fluoride programs are widely recognized as cost-effective and scalable, offering substantial benefits at the population level. Nevertheless, community-based preventive measures are often hindered by resource constraints, inequitable access, and in some cases political conflicts. In summary, oral diseases remain prevalent in the U.S. Limited public coverage, workforce shortages in rural or underserved areas, and uneven access to dental care highlight the need for systemic reforms to improve oral health equity. These findings point to the importance of strengthening dental public health research and coordinated policy action to reduce structural barriers and expand access to dental care. Full article

Objectives: This study examines how different benefit payment modes under China’s long-term care insurance (LTCI) program influence healthcare utilization and medical expenditures among middle-aged and older adults. Specifically, it compares the effects of in-kind benefits and mixed benefits on healthcare service use and financial burden. Methods: This study uses data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, focusing on middle-aged and older adults with functional limitations. Exploiting the staggered implementation of LTCI pilot programs across 14 cities, a difference-in-differences (DID) approach is employed to estimate the causal effects of different benefit payment modes on healthcare utilization and expenditures. Heterogeneity analyses are conducted to explore differences between rural and urban populations. Results: The results indicate that the in-kind benefit mode significantly reduces inpatient visits, total medical costs, and out-of-pocket expenditures. By contrast, the mixed benefit mode shows only a modest reduction observed mainly in outpatient visits. Heterogeneity analysis further reveals that in-kind benefits are particularly effective in reducing healthcare utilization and medical expenditures among rural residents, while urban residents experience higher reductions in out-of-pocket spending. Conclusions: These findings highlight the importance of benefit design in shaping the effectiveness of LTCI policies. Prioritizing service-based benefits may improve healthcare system efficiency and reduce financial burdens among older adults. The results provide policy-relevant insights for optimizing LTCI benefit design in China and other aging societies. Full article

Background: Chronic Obstructive Pulmonary Disease (COPD) poses a substantial public health challenge in China owing to its increasing prevalence and substantial economic burden. In response, the diagnosis–intervention packet (DIP) payment reform was implemented to control healthcare costs and enhance service efficiency. Methods: To evaluate the effect of the DIP reform on medical costs, hospitalization days, and individual out-of-pocket payments for COPD inpatients in M City, a pilot city in central China, we conducted an interrupted time series (ITS) analysis using monthly reimbursement records from January 2020 to December 2023. The study included 84,410 hospitalized patients from a city-wide database of 3,241,233 inpatient records with COPD who met the inclusion criteria. The analysis focused on the total healthcare costs, length of stay, and individual out-of-pocket costs. Results: The DIP reform resulted in a 3.7% reduction (95% CI: 0.9% to 6.5%) in the total hospitalization costs in the first month post-reform, with a sustained monthly decline of 0.8% (95% CI: 0.5% to 1.1%). The length of stay decreased from 9.53 (95% CI: 9.31 to 9.75) to 8.74 days (95% CI: 8.62 to 8.86). Conversely, the proportion of out-of-pocket payments relative to total costs increased. Conclusions: While the DIP reform effectively reduced hospitalization costs and days, it led to an increase in individual out-of-pocket payments. Future research should focus on optimizing payment rules, enhancing the supervision of medical services, and refining health insurance policies to achieve the reform’s objectives better and alleviate the financial burden on patients. Full article

Pediatric pneumonia remains a major cause of morbidity and mortality in low- and middle-income countries (LMICs), imposing both health and financial burdens. While the clinical aspects of pediatric pneumonia are well-studied, less attention has been paid to its economic implications for households, particularly regarding out-of-pocket (OOP) expenditure. This paper synthesizes current evidence from Kenya, India, Bangladesh, and Vietnam and introduces a proposed econometric framework designed to identify cost determinants and model policy interventions. The framework integrates microeconomic data, identifies cost determinants, and models the effects of clinical and policy factors (e.g., intensive care, vaccination, insurance coverage) on household expenditures. Simulated results illustrate potential findings from such an approach. Existing studies show substantial variability in hospitalization costs, with OOP payments ranging from US$30 to US$250 per episode, often exceeding 20% of monthly household income. Econometric modeling using generalized linear models (GLMs) and difference-in-differences (DiD) can disentangle the impact of hospital practices, disease severity, and policy interventions. Simulated regression results demonstrate that length of stay, intensive care admission, and absence of insurance significantly increase household costs, while pneumococcal conjugate vaccine (PCV) introduction reduces both admissions and financial burden. Hospitalization for pediatric pneumonia imposes significant OOP costs on households in LMICs. An econometric framework provides rigorous tools to estimate cost drivers, evaluate policy impacts, and guide equitable health financing reforms. Full article

National legislative frameworks governing prescribing, pricing, reimbursement, and dispensing play a decisive role in shaping access to medicines. This study examines the financial availability of medicines in Bulgaria and North Macedonia through a comparative review of national pharmaceutical legislation, pricing mechanisms, reimbursement models, and digitalisation policies, assessed in relation to European Union standards. The findings indicate that access to medicines in both countries is shaped by the combined effects of multiple regulatory and financial instruments rather than by individual policy measures. Both systems apply strict control of prescribing and dispensing, external reference pricing, and positive reimbursement lists, reflecting alignment with international recommendations. However, significant differences in policy design lead to divergent access outcomes. Bulgaria’s more advanced digitalisation of prescribing and reimbursement, including mandatory electronic prescribing for selected therapeutic groups, enhances regulatory oversight and expenditure control but is associated with higher patient out-of-pocket expenditure, partly due to the application of the standard value-added tax on medicines. In contrast, North Macedonia combines lower taxation with capped patient co-payments, higher regulated pharmacy margins, and fixed pharmacy remuneration per prescription, contributing to improved financial affordability for patients while supporting pharmacy sustainability. Additional instruments, such as the Generics without Co-Payment List, further strengthen patient financial protection. The study provides comparative evidence relevant to pharmaceutical policy reforms and highlights the importance of balanced regulatory approaches that promote affordability, system sustainability, and equitable access to medicines. Full article

Background/Objectives: Financial toxicity (FT) refers to the financial burden directly or indirectly caused by a patient’s medical care. Patients with head and neck cancer (HNC) are particularly vulnerable to FT due to lower rates of return to work and higher out-of-pocket payments (OOPP). In this cross-sectional study, we assessed the amount and types of OOPP, as well as the prevalence of FT, in HNC patients who had completed curative radiotherapy. Methods: We included HNC patients who underwent curative-intent radiotherapy at four private clinics in Romania, within 12 months of completing treatment. Participants completed a 25-item questionnaire capturing sociodemographic information, insurance status, income, and OOPP. To assess subjective FT, we used the validated nine-item Financial Index of Toxicity (FIT), which measures three FT domains: financial stress, financial strain, and lost productivity. Each domain and the total score range from 0 to 100, with higher scores indicating greater financial toxicity. Descriptive statistics were used to summarize patient characteristics. Pearson’s chi-square, t-tests, and one-way ANOVA were used to assess statistical associations, with a significance threshold of p < 0.05. Results: Among 113 patients (mean age: 59), the majority were male (74.3%) and married (74.3%), with 40% having completed university or higher education. The most frequent tumor sites were the oropharynx (29 cases), larynx (22), and oral cavity (21). Concurrent chemoradiation was the most common treatment modality (47%). The mean total FT score was 18.8. Overall, 39.8% of patients experienced financial toxicity, and 29.2% scored above the mean in financial stress. Moderate financial strain (score > 21) was reported by 39.8% of participants, and approximately one-third reported loss of productivity. Transportation and nutritional supplements were the most common OOPP categories. Notably, 42% of patients spent at least 400 euros—equivalent to Romania’s monthly minimum income—on transportation during radiotherapy. FT was significantly associated with employment and marital status, but not with tumor site or treatment type. Conclusions: Among Romanian HNC patients treated with curative radiotherapy, we found substantial OOPP, particularly for transportation and nutritional supplements. While overall FT levels were moderate, divorced patients and those retired due to other chronic conditions were the most vulnerable to financial distress. Financial toxicity can directly affect treatment adherence, survival, and quality of life. By integrating financial counseling, social support, and broader coverage of treatment-related expenses, healthcare systems can mitigate FT for these patients. Full article

Health financing is a core determinant of the resilience and equity of health systems. Using WHO’s three-pillar framework as an orienting reference—rather than a prescriptive template—this article analyzes the evolution, structural shortcomings, and policy dilemmas of the Greek health financing model, within a comparative European context. While many EU countries have strengthened public financing to ensure universal access, Greece maintains a hybrid, fragmented model in which out-of-pocket payments play a disproportionately large role. Despite recurrent reform attempts, Greece has not developed a cohesive public system with a clear commitment to social solidarity. Instead, the system has silently shifted into a de facto semi-privatized two-tier model that exacerbates social inequities, limits access and undermines efficiency. Drawing on international experience and documented policy lessons, the article proposes a strategic redesign of the health financing architecture. The proposal is conceptual and does not enter implementation specifics. Its central axis is the establishment of two national single purchasers of health services by level of care, with a clear allocation of responsibilities and authority, the Ministry of Health for hospital care, and the National Organization for Healthcare Services Provision (EOPYY) for primary, outpatient, and post-acute/rehabilitation care, to strengthen prevention, equitable access, and chronic care management while easing pressure on hospitals. The proposed model includes targeted investments in human resources and infrastructure, the enhancement of prospective payment mechanisms, the strengthening of primary care networks, and the leveraging of innovation. At the same time, it provides for reforms in governance, digital transformation of the system, and reallocation of resources based on principles of equity and efficiency. The proposed overall restructuring aims to strengthen financial protection, reduce inequities in access, and improve health outcomes through a publicly oriented, socially responsive, and strategically governed system. Full article

Background: Caesarean section (CS) is a critical intervention, yet stark inequities in access persist across low- and middle-income countries (LMICs). Over the last decade, governments have introduced policies to eliminate or subsidize user fees; however, the collective impact of these initiatives on utilization, equity, and financial protection has not been fully synthesized. Methods: We conducted a systematic review in line with PRISMA 2020 guidelines. Searches were conducted in PubMed, Dimensions, Google Scholar, Scopus, Web of Science, and government portals for studies published between 1 January 2009 and 30 May 2025. Eligible studies evaluated government-initiated financing reforms, including full user-fee exemptions, partial subsidies, vouchers, insurance schemes, and provider-payment restructuring. Two reviewers independently applied the PICOS criteria, extracted data using a 15-item template, and assessed the study quality. Given heterogeneity, results were synthesized narratively. Results: Thirty-seven studies from 28 LMICs were included. Most (70%) evaluated fee exemptions. Mixed-methods and cross-sectional designs predominated, while only six studies employed interrupted time series designs. Twenty-two evaluations (59%) reported increased CS uptake, ranging from a 1.4-fold rise in Senegal to a threefold increase in Kano State, Nigeria. Similar surges were also observed in non-African contexts such as Iran and Georgia, where reforms included incentives for vaginal delivery or punitive tariffs to curb overuse. Fourteen of 26 fee-exemption studies documented pro-rich or pro-urban drift, while catastrophic expenditure persisted for 12–43% of households, despite the implementation of “free” policies. Median out-of-pocket costs ranged from USD 14 in Burkina Faso to nearly USD 300 in Dakar’s slums. Only one study linked reforms to a reduction in neonatal mortality (a 30% decrease in Mali/Benin), while none demonstrated an impact on maternal mortality. Qualitative evidence highlighted hidden costs, delayed reimbursements, and weak accountability. At the same time, China and Bangladesh demonstrated how demographic reforms or voucher schemes could inadvertently lead to CS overuse or expose gaps in service readiness. Conclusions: Government-led financing reforms consistently increased CS volumes but fell short of ensuring equity, financial protection, or sustained quality. Effective initiatives combined fee removal with investments in surgical capacity, timely reimbursement, and transparent accountability. Future CS policies must integrate real-time monitoring of equity and quality and adopt robust quasi-experimental designs to enable mid-course correction. Full article