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The 1996 User Fee Abolition in South Africa: A Difference-in-Difference Analysis

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  • Anna S. Brink

    ()
    (Department of Economics, University of Pretoria)

  • Steven F. Koch

    ()
    (Department of Economics, University of Pretoria)

Abstract

South Africa waived user fees for primary health care, first in 1994, and again, in 1996. Since the 1994 plan focused on young children and older adults, as well as pregnant and nursing mothers, the 1996 change, which waived fees for the remainder of the population, subject to means tests, can be examined via differences-in-differences (DD). DD is applied to a subsample of children, underpinned by a multinomial logit regression of health-seeking behavior amongst ill and injured children. Although the policy provided free primary care to all at public clinics, the results of the analysis do not support the hypothesis that free primary care significantly increased public clinic visits amongst ill and injured children. However, there is strong evidence that ill and injured children were more likely (by 6%) to seek at least some sort of treatment following the change in policy, implying that the policy was indirectly successful.

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Bibliographic Info

Paper provided by University of Pretoria, Department of Economics in its series Working Papers with number 201332.

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Length: 23 pages
Date of creation: Jul 2013
Date of revision:
Handle: RePEc:pre:wpaper:201332

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  1. Christelle Grobler & Ian c. Stuart, 2007. "Health Care Provider Choice," South African Journal of Economics, Economic Society of South Africa, vol. 75(2), pages 327-350, 06.
  2. David Card & Alan Krueger, 1993. "Minimum Wages and Employment: A Case Study of the Fast Food Industry in New Jersey and Pennsylvania," Working Papers 694, Princeton University, Department of Economics, Industrial Relations Section..
  3. Olufunke Alaba & Steven Koch, 2009. "Dynamic Health Care Decisions and Child Health in South Africa," Working Papers 142, Economic Research Southern Africa.
  4. Marcel Fafchamps & Bart Minten, 2003. "Public Service Provision, User Fees, and Political Turmoil," Economics Series Working Papers WPS/2003-15, University of Oxford, Department of Economics.
  5. Michael Grossman, 1999. "The Human Capital Model of the Demand for Health," NBER Working Papers 7078, National Bureau of Economic Research, Inc.
  6. 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.
  7. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2002. "How Much Should We Trust Differences-in-Differences Estimates?," NBER Working Papers 8841, National Bureau of Economic Research, Inc.
  8. Roy Havemann & Servaas van der Berg, 2002. "The demand for health care in South Africa," Working Papers 06/2002, Stellenbosch University, Department of Economics.
  9. 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.
  10. Mariko, Mamadou, 2003. "Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components," Social Science & Medicine, Elsevier, vol. 56(6), pages 1183-1196, March.
  11. Mbugua, J. Karanja & Bloom, Gerald H. & Segall, Malcolm M., 1995. "Impact of user charges on vulnerable groups: The case of Kibwezi in rural Kenya," Social Science & Medicine, Elsevier, vol. 41(6), pages 829-835, September.
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