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The Abolition Of User Fees And The Demand For Health Care: Re-Evaluating The Impact

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Author Info

  • Steven F. Koch

    ()
    (Department of Economics, University of Pretoria)

Abstract

The abolition of user fees in South Africa, a policy implemented in 1994 for children under the age of six and the elderly, as well as pregnant and nursing mothers, is examined via regression discontinuity. The analysis focuses on provider choice decisions for curative care treatment, but also examines potential externalities that could arise from the policy. As a result of the policy, curative care demand in the public sector is found to increase by approximately 7%; however, the demand for curative care in the private sector is found to decrease by nearly the same amount, suggesting that the policy led to provider choice substitution. The analysis further supports the hypothesis that the health of young children improved marginally.

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Bibliographic Info

Paper provided by University of Pretoria, Department of Economics in its series Working Papers with number 201219.

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Length: 41 pages
Date of creation: May 2012
Date of revision:
Handle: RePEc:pre:wpaper:201219

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Keywords: Free Health Care; Regression Discontinuity;

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References

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  1. David S. Lee & Thomas Lemieux, 2010. "Regression Discontinuity Designs in Economics," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 281-355, June.
  2. Ronelle Burger & Christelle Swanepoel, 2006. "Have pro-poor health policies improved the targeting of spending and the effective delivery of health care in South Africa?," Working Papers 12/2006, Stellenbosch University, Department of Economics.
  3. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-58, December.
  4. Marianne Bertrand & Sendhil Mullainathan & Douglas Miller, 2003. "Public Policy and Extended Families: Evidence from Pensions in South Africa," World Bank Economic Review, World Bank Group, vol. 17(1), pages 27-50, June.
  5. Klaus Deininger & Paul Mpuga, 2005. "Economic and Welfare Impact of the Abolition of Health User Fees: Evidence from Uganda," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 14(1), pages 55-91, March.
  6. Christelle Swanepoel & Ian Stuart, 2006. "Health Care Provider Choice," Working Papers 11/2006, Stellenbosch University, Department of Economics.
  7. Victor R. Fuchs, 1968. "The Growing Demand for Medical Care," NBER Chapters, in: The Growing Demand for Medical Care, pages 1-8 National Bureau of Economic Research, Inc.
  8. Lee, David S., 2008. "Randomized experiments from non-random selection in U.S. House elections," Journal of Econometrics, Elsevier, vol. 142(2), pages 675-697, February.
  9. Paul J. Gertler & Luis Locay & Warren C. Sanderson, 1987. "Are User Fees Regressive? The Welfare Implications of Health Care Financing Proposals in Peru," NBER Working Papers 2299, National Bureau of Economic Research, Inc.
  10. Heller, Peter S., 1982. "A model of the demand for medical and health services in Peninsular Malaysia," Social Science & Medicine, Elsevier, vol. 16(3), pages 267-284, January.
  11. Xu, Ke & Evans, David B. & Kadama, Patrick & Nabyonga, Juliet & Ogwal, Peter Ogwang & Nabukhonzo, Pamela & Aguilar, Ana Mylena, 2006. "Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda," Social Science & Medicine, Elsevier, vol. 62(4), pages 866-876, February.
  12. Roy Havemann & Servaas van der Berg, 2002. "The demand for health care in South Africa," Working Papers 06/2002, Stellenbosch University, Department of Economics.
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Cited by:
  1. Steven F. Koch & Jeffrey S. Racine, 2013. "Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting," Department of Economics Working Papers 2013-14, McMaster University.

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