IDEAS home Printed from https://ideas.repec.org/a/eee/wdevel/v101y2018icp334-350.html
   My bibliography  Save this article

Does Free Public Health Care Increase Utilization and Reduce Spending? Heterogeneity and Long-Term Effects

Author

Listed:
  • Hangoma, Peter
  • Robberstad, Bjarne
  • Aakvik, Arild

Abstract

Zambia removed user fees in publicly supported–government and faith-based–health facilities in 54 out of 72 districts in 2006. This was extended to rural areas of previously unaffected districts in 2007. The natural experiment provided by the step-wise implementation of the removal policy and five waves of nationally representative household survey data enables us to study the impact of the removal policy on utilization and household health expenditure. We find that the policy increased overall use of health services in the short term and the effects were sustained in the long term. The increases were higher for individuals whose household heads were unemployed or had no or less education. The policy also led to a small shift in care seeking from private to publicly supported facilities, an effect driven primarily by individuals whose household heads were either formally employed or engaged in farming. The likelihood of incurring any spending reduced, although this weakened slightly in the long term. At the same time, there was an upward pressure on conditional health expenditure, i.e., expenditure was higher after removal of fees for those who incurred any spending. Hence, total (unconditional) household health expenditure was not significantly affected.

Suggested Citation

  • Hangoma, Peter & Robberstad, Bjarne & Aakvik, Arild, 2018. "Does Free Public Health Care Increase Utilization and Reduce Spending? Heterogeneity and Long-Term Effects," World Development, Elsevier, vol. 101(C), pages 334-350.
    • Handle: RePEc:eee:wdevel:v:101:y:2018:i:c:p:334-350
    DOI: 10.1016/j.worlddev.2017.05.040
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0305750X17302140
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.worlddev.2017.05.040?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Renard, Yohan, 2022. "From fees to free: User fee removal, maternal health care utilization and child health in Zambia," World Development, Elsevier, vol. 156(C).
    2. El-Shal, Amira & Cubi-Molla, Patricia & Jofre-Bonet, Mireia, 2021. "Are user fees in health care always evil? Evidence from family planning, maternal, and child health services," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 506-529.
    3. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    4. Kraft, Kornelius & Lammers, Alexander, 2021. "The Effects of Reforming a Federal Employment Agency on Labor Demand," IZA Discussion Papers 14629, Institute of Labor Economics (IZA).
    5. Giebel, Marek & Kraft, Kornelius, 2017. "External financing constraints and firm's innovative activities during the financial crisis," ZEW Discussion Papers 17-064, ZEW - Leibniz Centre for European Economic Research.
    6. Nagano, Hitoshi & Puppim de Oliveira, Jose A. & Barros, Allan Kardec & Costa Junior, Altair da Silva, 2020. "The ‘Heart Kuznets Curve’? Understanding the relations between economic development and cardiac conditions," World Development, Elsevier, vol. 132(C).
    7. Giebel, Marek & Kraft, Kornelius, 2020. "R&D investment under financing constraints," ZEW Discussion Papers 20-018, ZEW - Leibniz Centre for European Economic Research.
    8. Raphaël Cottin, 2018. "Free health care for the poor: a good way to achieve universal health coverage? Evidence from Morocco," Working Papers DT/2018/16, DIAL (Développement, Institutions et Mondialisation).
    9. Rafael Aguirre Unceta, 2021. "Mining revenue, fiscal space and social policies: the case of Zambia," Working Papers 191, International Policy Centre for Inclusive Growth.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:wdevel:v:101:y:2018:i:c:p:334-350. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/worlddev .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.