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

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.