EconPapers    
Economics at your fingertips  
 

Does Free Public Health Care Increase Utilization and Reduce Spending? Heterogeneity and Long-Term Effects

Peter Hangoma, Bjarne Robberstad and Arild Aakvik

World Development, 2018, vol. 101, issue C, 334-350

Abstract: Zambia removed user fees in publicly supported–government and faith-based–health facilities in 54 out of 72 districts in 2006. This was extended to rural areas of previously unaffected districts in 2007. The natural experiment provided by the step-wise implementation of the removal policy and five waves of nationally representative household survey data enables us to study the impact of the removal policy on utilization and household health expenditure. We find that the policy increased overall use of health services in the short term and the effects were sustained in the long term. The increases were higher for individuals whose household heads were unemployed or had no or less education. The policy also led to a small shift in care seeking from private to publicly supported facilities, an effect driven primarily by individuals whose household heads were either formally employed or engaged in farming. The likelihood of incurring any spending reduced, although this weakened slightly in the long term. At the same time, there was an upward pressure on conditional health expenditure, i.e., expenditure was higher after removal of fees for those who incurred any spending. Hence, total (unconditional) household health expenditure was not significantly affected.

Keywords: user fees; utilization; medical spending; long term; heterogeneity; Zambia (search for similar items in EconPapers)
Date: 2018
References: Add references at CitEc
Citations: View citations in EconPapers (9) Track citations by RSS feed

Downloads: (external link)
http://www.sciencedirect.com/science/article/pii/S0305750X17302140
Full text for ScienceDirect subscribers only

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:eee:wdevel:v:101:y:2018:i:c:p:334-350

DOI: 10.1016/j.worlddev.2017.05.040

Access Statistics for this article

World Development is currently edited by O. T. Coomes

More articles in World Development from Elsevier
Bibliographic data for series maintained by Catherine Liu ().

 
Page updated 2022-07-26
Handle: RePEc:eee:wdevel:v:101:y:2018:i:c:p:334-350