Advanced Search
MyIDEAS: Login

Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda

Contents:

Author Info

  • Xu, Ke
  • Evans, David B.
  • Kadama, Patrick
  • Nabyonga, Juliet
  • Ogwal, Peter Ogwang
  • Nabukhonzo, Pamela
  • Aguilar, Ana Mylena
Registered author(s):

    Abstract

    There is currently considerable discussion between governments, international agencies, bilateral donors and advocacy groups on whether user fees levied at government health facilities in poor countries should be abolished. It is claimed that this would lead to greater access for the poor and reduce the risks of catastrophic health expenditures if all other factors remained constant, though other factors rarely remain constant in practice. Accordingly, it is important to understand what has actually happened when user fees have been abolished, and why. All fees at first level government health facilities in Uganda were removed in March 2001. This study explores the impact on health service utilization and catastrophic health expenditures using data from National Household Surveys undertaken in 1997, 2000 and 2003. Utilization increased for the non-poor, but at a lower rate than it had in the period immediately before fees were abolished. Utilization among the poor increased much more rapidly after the abolition of fees than beforehand. Unexpectedly, the incidence of catastrophic health expenditure among the poor did not fall. The most likely explanation is that frequent unavailability of drugs at government facilities after 2001 forced patients to purchase from private pharmacies. Informal payments to health workers may also have increased to offset the lost revenue from fees. Countries thinking of removing user charges should first examine what types of activities and inputs at the facility level are funded from the revenue collected by fees, and then develop mechanisms to ensure that these activities can be sustained subsequently.

    Download Info

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
    File URL: http://www.sciencedirect.com/science/article/B6VBF-4H100B4-2/2/edaabde9608c032b48f099753e4e7af0
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 62 (2006)
    Issue (Month): 4 (February)
    Pages: 866-876

    as in new window
    Handle: RePEc:eee:socmed:v:62:y:2006:i:4:p:866-876

    Contact details of provider:
    Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description

    Order Information:
    Postal: http://www.elsevier.com/wps/find/supportfaq.cws_home/regional
    Web: http://www.elsevier.com/orderme/journalorderform.cws_home/315/journalorderform1/orderooc/id=654&ref=654_01_ooc_1&version=01

    Related research

    Keywords: User charges Service utilization Catastrophic expenditure Uganda;

    References

    No references listed on IDEAS
    You can help add them by filling out this form.

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as in new window

    Cited by:
    1. Steven F. Koch, 2012. "The Abolition Of User Fees And The Demand For Health Care: Re-Evaluating The Impact," Working Papers 201219, University of Pretoria, Department of Economics.
    2. Hadley, Mary, 2011. "Does increase in utilisation rates alone indicate the success of a user fee removal policy? A qualitative case study from Zambia," Health Policy, Elsevier, vol. 103(2), pages 244-254.
    3. Steven F. Koch, 2013. "User Fee Abolition in South Africa: Re-Evaluating the Impact?," Working Papers 201331, University of Pretoria, Department of Economics.
    4. Kim, Chang-O & Joung, Won Oh, 2014. "Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: A quasi-experimental study," Social Science & Medicine, Elsevier, vol. 101(C), pages 28-35.
    5. Akbari, Ather H. & Rankaduwa, Wimal & Kiani, Adiqa, 2009. "Demand for Public Health Care in Pakistan," MPRA Paper 27874, University Library of Munich, Germany.
    6. Xu, Ke & Ravndal, Frode & Evans, David B. & Carrin, Guy, 2009. "Assessing the reliability of household expenditure data: Results of the World Health Survey," Health Policy, Elsevier, vol. 91(3), pages 297-305, August.
    7. Johnson, Ari & Goss, Adeline & Beckerman, Jessica & Castro, Arachu, 2012. "Hidden costs: The direct and indirect impact of user fees on access to malaria treatment and primary care in Mali," Social Science & Medicine, Elsevier, vol. 75(10), pages 1786-1792.
    8. Anna S. Brink & Steven F. Koch, 2013. "The 1996 User Fee Abolition in South Africa: A Difference-in-Difference Analysis," Working Papers 201332, University of Pretoria, Department of Economics.

    Lists

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    Statistics

    Access and download statistics

    Corrections

    When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:62:y:2006:i:4:p:866-876. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Zhang, Lei).

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.