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User charges for health services in developing countries: A review of the economic literature

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  • McPake, Barbara

Abstract

Literature suggests that in theory, the efficiency of user charges for health services is related to the level of externality, the price elasticity of demand, the proportion of total costs which are private access costs, and the level of the government budget constraint. Theoretical models predict that price elasticity of demand for health services is likely to be higher for lower income groups and that user charges are therefore unlikely to promote equity, or reduce the discrepancies between the utilisation rates of the rich and poor, 'ceteris paribus'. Empirical evidence tends to confirm the latter prediction but to suggest that user charges in many countries provide the scope for welfare gains for the majority. Unfortunately, this scope is seldom exploited in practice. It is argued that many countries have little choice but to try to exploit the potential for majority gains, but that more emphasis should be placed on ensuring quality improvements than on superficial financial measures of success.

Suggested Citation

  • McPake, Barbara, 1993. "User charges for health services in developing countries: A review of the economic literature," Social Science & Medicine, Elsevier, vol. 36(11), pages 1397-1405, June.
  • Handle: RePEc:eee:socmed:v:36:y:1993:i:11:p:1397-1405
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    References listed on IDEAS

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    Citations

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    Cited by:

    1. Gilson, Lucy & Mills, Anne, 1995. "Health sector reforms in sub-Saharan Africa: lessons of the last 10 years," Health Policy, Elsevier, vol. 32(1-3), pages 215-243.
    2. Michael Kremer & Edward Miguel, 2007. "The Illusion of Sustainability," The Quarterly Journal of Economics, Oxford University Press, vol. 122(3), pages 1007-1065.
    3. Ian Anderson, 2014. "Health Financing in Vanuatu : Challenges and Options," Health, Nutrition and Population (HNP) Discussion Paper Series 89505, The World Bank.
    4. Ensor, Tim & Ronoh, Jeptepkeny, 2005. "Effective financing of maternal health services: A review of the literature," Health Policy, Elsevier, vol. 75(1), pages 49-58, December.
    5. World Bank, 2004. "The Republic of Uganda : Country Integrated Fiduciary Assessment 2004, Volume 1. Main Report," World Bank Other Operational Studies 15681, The World Bank.
    6. Ardeshir Sepehri & Robert Chernomas, 2001. "Are user charges efficiency- and equity-enhancing? A critical review of economic literature with particular reference to experience from developing countries," Journal of International Development, John Wiley & Sons, Ltd., vol. 13(2), pages 183-209.
    7. 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.
    8. Asfaw, Abay & Braun, Joachim von & Klasen, Stephan, 2004. "How Big is the Crowding-Out Effect of User Fees in the Rural Areas of Ethiopia? Implications for Equity and Resources Mobilization," World Development, Elsevier, vol. 32(12), pages 2065-2081, December.
    9. Gilson, Lucy & Kalyalya, Denny & Kuchler, Felix & Lake, Sally & Oranga, Hezron & Ouendo, Marius, 2001. "Strategies for promoting equity: experience with community financing in three African countries," Health Policy, Elsevier, vol. 58(1), pages 37-67, October.
    10. Ian Anderson, 2013. "Health Financing Options for Samoa : Challenges and Opportunities," Health, Nutrition and Population (HNP) Discussion Paper Series 89506, The World Bank.
    11. Smith, Peter C., 2005. "User charges and priority setting in health care: balancing equity and efficiency," Journal of Health Economics, Elsevier, vol. 24(5), pages 1018-1029, September.
    12. Deininger, Klaus & Mpuga, Paul, 2004. "Economic and Welfare Effects of the Abolition of Health User Fees : Evidence from Uganda," Policy Research Working Paper Series 3276, The World Bank.
    13. Michael Kremer & Alix Peterson Zwane, 2007. "Cost-Effective Prevention of Diarrheal Diseases: A Critical Review," Working Papers 117, Center for Global Development.
    14. De Allegri, Manuela & Ridde, Valéry & Louis, Valérie R. & Sarker, Malabika & Tiendrebéogo, Justin & Yé, Maurice & Müller, Olaf & Jahn, Albrecht, 2011. "Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso," Health Policy, Elsevier, vol. 99(3), pages 210-218, March.
    15. Srivastava, Divya & McGuire, Alistair, 2015. "Patient access to health care and medicines across low-income countries," Social Science & Medicine, Elsevier, pages 21-27.
    16. Cisse, Boubou & Luchini, Stephane & Moatti, Jean Paul, 2007. "Progressivity and horizontal equity in health care finance and delivery: What about Africa?," Health Policy, Elsevier, vol. 80(1), pages 51-68, January.
    17. Danyliv, Andriy & Groot, Wim & Gryga, Irena & Pavlova, Milena, 2014. "Willingness and ability to pay for physician services in six Central and Eastern European countries," Health Policy, Elsevier, vol. 117(1), pages 72-82.
    18. World Bank, 2004. "The Republic of Uganda : Country Integrated Fiduciary Assessment 2004, Volume 2. Public Expenditure Review 2004 - Promoting the Efficient Use of Public Resources for Poverty Eradication," World Bank Other Operational Studies 14511, The World Bank.
    19. Hentschel, Jesko, 1998. "Distinguishing between types of data and methods of collecting them," Policy Research Working Paper Series 1914, The World Bank.
    20. Gertler, Paul J. & Hammer, Jeffrey S., 1997. "Strategies for pricing publicly provided health services," Policy Research Working Paper Series 1762, The World Bank.
    21. Gonzalez Block, Miguel Angel, 1997. "Comparative research and analysis methods for shared learning from health system reforms," Health Policy, Elsevier, vol. 42(3), pages 187-209, December.
    22. Miloud Kaddar & Friedeger Stierle & Bergis Schmidt-Ehry & Anastase Tchicaya, 2000. "L'accès des indigents aux soins de santé en Afrique subsaharienne," Revue Tiers Monde, Programme National Persée, vol. 41(164), pages 903-925.
    23. Dyna Arhin-Tenkorang, 2001. "Mobilizing Resources for Health: The Case for User Fees Revisited," CID Working Papers 81, Center for International Development at Harvard University.

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