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Does Abolishing User Fees Lead to Improved Health Status? Evidence from Post-apartheid South Africa

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  • Shinsuke Tanaka

Abstract

Whether user fees for health services should be charged or abolished for the poor has recently been debated. This study examines the impact on child health status of removing user fees in South Africa. Our main innovation is to exploit plausibly exogenous variation in access to free health care, due to the fact that black Africans under apartheid could exercise little political power and residential choice. We find substantial improvements in weight-for-age z-scores among ex ante similar children. Falsification exercises confirm no preexisting trend in the pre-reform period or no treatment effect among noneligible children in the post-reform period.

Suggested Citation

  • Shinsuke Tanaka, 2014. "Does Abolishing User Fees Lead to Improved Health Status? Evidence from Post-apartheid South Africa," American Economic Journal: Economic Policy, American Economic Association, vol. 6(3), pages 282-312, August.
  • Handle: RePEc:aea:aejpol:v:6:y:2014:i:3:p:282-312
    Note: DOI: 10.1257/pol.6.3.282
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    References listed on IDEAS

    as
    1. Esther Duflo, 2003. "Grandmothers and Granddaughters: Old-Age Pensions and Intrahousehold Allocation in South Africa," World Bank Economic Review, World Bank Group, vol. 17(1), pages 1-25, June.
    2. Carter, Michael R. & Maluccio, John A., 2003. "Social Capital and Coping with Economic Shocks: An Analysis of Stunting of South African Children," World Development, Elsevier, vol. 31(7), pages 1147-1163, July.
    3. Harris, Jody & Drimie, Scott, 2012. "Toward an integrated approach for addressing malnutrition in Zambia: a literature review and institutional analysis:," IFPRI discussion papers 1200, International Food Policy Research Institute (IFPRI).
    Full references (including those not matched with items on IDEAS)

    Citations

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    Cited by:

    1. Branson, Nicola & Byker, Tanya, 2018. "Causes and consequences of teen childbearing: Evidence from a reproductive health intervention in South Africa," Journal of Health Economics, Elsevier, vol. 57(C), pages 221-235.
    2. repec:eee:deveco:v:130:y:2018:i:c:p:33-44 is not listed on IDEAS
    3. Maria Kuecken & Josselin Thuilliez & Marie-Anne Valfort, 2013. "Large-scale health interventions and education: Evidence from Roll Back Malaria in Africa," Documents de travail du Centre d'Economie de la Sorbonne 13075r, Université Panthéon-Sorbonne (Paris 1), Centre d'Economie de la Sorbonne, revised Jun 2015.
    4. repec:bla:sajeco:v:85:y:2017:i:2:p:242-258 is not listed on IDEAS
    5. Ito, Takahiro & Tanaka, Shinsuke, 2018. "Abolishing user fees, fertility choice, and educational attainment," Journal of Development Economics, Elsevier, vol. 130(C), pages 33-44.

    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration
    • O17 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Formal and Informal Sectors; Shadow Economy; Institutional Arrangements

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