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

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  • 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
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    Citations

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    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. Guan, Hongyu & Zhang, Yunyun & Du, Kang & Wang, Zhijie & Shi, Yaojiang, 2024. "Revisit the one-time subsidies and long-run adoption of health products: Quasi-experimental evidence from providing free eyeglasses in rural China," World Development, Elsevier, vol. 179(C).
    8. Giebel, Marek & Kraft, Kornelius, 2020. "R&D investment under financing constraints," ZEW Discussion Papers 20-018, ZEW - Leibniz Centre for European Economic Research.
    9. 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).
    10. Rafael Aguirre Unceta, 2021. "Mining revenue, fiscal space and social policies: the case of Zambia," Working Papers 191, International Policy Centre for Inclusive Growth.

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