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Impact of user charges on vulnerable groups: The case of Kibwezi in rural Kenya

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  • Mbugua, J. Karanja
  • Bloom, Gerald H.
  • Segall, Malcolm M.
Abstract
The Government of Kenya introduced user fees for inpatient and curative outpatient care at its hospitals and health centres in December 1989. Children under five years old and those judged by the health staff to be indigent were among the groups exempted from fees. In September 1990, outpatient registration fees were removed, but other fees were retained. This paper describes the effects of these policy changes on the use of health services in Kibwezi division, a poor rural area. It focuses particularly on the impact of the fees on access to care by children and the poor. The assessment is based on attendance data from government health facilities and on a longitudinal household survey of health care utilization, which covered the nine months during which all fees were charged and two months following the removal of the registration fees. Attendance at government fee-charging health facilities for both outpatient and inpatient care was lower during the period when full fees were charged than during the same months of the previous year. Outpatient attendances rose again when the registration fees were lifted. The study households reported lower levels of utilization of public hospitals and health centres when full fees were in force than during the period after the registration fees were lifted. The pattern of utilization by young children, who were exempted from fees, mirrored that of the rest of the population, suggesting that they were not fully protected from the adverse effects of fees. The poorest households made much less use of the fee-charging government facilities than the better-off households. The exemption system did not protect them from the adverse effects of the fees.

Suggested Citation

  • 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.
    • Handle: RePEc:eee:socmed:v:41:y:1995:i:6:p:829-835
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    Citations

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    Cited by:

    1. Simon Appleton, 2000. "Education and Health at the Household Level in Sub-Saharan Africa," CID Working Papers 33A, Center for International Development at Harvard University.
    2. 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.
    3. Anna S. Brink & Steven F. Koch, 2013. "The 1996 User Fee Abolition in South Africa: A Difference-in-Difference Analysis," Working Papers 201332, University of Pretoria, Department of Economics.
    4. Kasirye, Ibrahim & Ssewanyana, Sarah & Nabyonga, Juliet & Lawson, David, 2004. "Demand for health care services in Uganda: Implications for poverty reduction," MPRA Paper 8558, University Library of Munich, Germany.
    5. Tibandebage, Paula & Mackintosh, Maureen, 2005. "The market shaping of charges, trust and abuse: health care transactions in Tanzania," Social Science & Medicine, Elsevier, vol. 61(7), pages 1385-1395, October.
    6. Winnie Yip & Peter Berman, 2001. "Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 10(3), pages 207-220, April.
    7. Gertler, Paul J. & Hammer, Jeffrey S., 1997. "Strategies for pricing publicly provided health services," Policy Research Working Paper Series 1762, The World Bank.
    8. 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.
    9. Onwujekwe, Obinna & Uzochukwu, Benjamin, 2005. "Socio-economic and geographic differentials in costs and payment strategies for primary healthcare services in Southeast Nigeria," Health Policy, Elsevier, vol. 71(3), pages 383-397, March.
    10. Oyaya, Charles O. & Rifkin, Susan B., 2003. "Health sector reforms in Kenya: an examination of district level planning," Health Policy, Elsevier, vol. 64(1), pages 113-127, April.
    11. Smith, Kimberly V. & Sulzbach, Sara, 2008. "Community-based health insurance and access to maternal health services: Evidence from three West African countries," Social Science & Medicine, Elsevier, vol. 66(12), pages 2460-2473, June.
    12. Onwujekwe, Obinna, 2005. "Inequities in healthcare seeking in the treatment of communicable endemic diseases in Southeast Nigeria," Social Science & Medicine, Elsevier, vol. 61(2), pages 455-463, July.
    13. Patrick Sakdapolrak & Thomas Seyler & Christina Ergler, 2013. "Burden of direct and indirect costs of illness: Empirical findings from slum settlements in Chennai, South India," Progress in Development Studies, , vol. 13(2), pages 135-151, April.

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