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Are people willing and able to pay for health services?

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  • Yoder, Richard A.

Abstract

Following a nationwide increase in user fees for health services in Swaziland, this paper analyzes the effect of the fee increase on overall patient use of health services, on which types of services, curative vs preventive, were most affected, and on changes in utilization by higher paying and lower paying groups. Patient attendance data from a 71% sample of government and mission health facilities, suggests that the 'people are willing and able to pay for health services' assertion is not supported by the Swaziland case. Following the fee increase, average attendance decreased at government facilities by 32.4%, increased at mission facilities by 10.2%, leading to a combined decline of approx. 17%. Patient visits designed to protect against childhood diseases, BCG and DPT immunizations, or against dehydration in children, show average attendance decline of -16, -19, and -24%, respectively, while visits for musculoskeletal diseases, a less serious disease, declined 1.2%. The analysis also suggests that up to 34% of the overall decline in attendance was among patients who previously had paid the least for health care with part of this decline likely including fewer multiple visits.

Suggested Citation

  • Yoder, Richard A., 1989. "Are people willing and able to pay for health services?," Social Science & Medicine, Elsevier, vol. 29(1), pages 35-42, January.
    • Handle: RePEc:eee:socmed:v:29:y:1989:i:1:p:35-42
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    Cited by:

    1. Mocan, H. Naci & Tekin, Erdal & Zax, Jeffrey S., 2004. "The Demand for Medical Care in Urban China," World Development, Elsevier, vol. 32(2), pages 289-304, February.
    2. Dow, W.H., 1995. "Welfare Impacts of Health Case User Fees : A Health- Valuation Approach to Analysis with Imperfect Markets," Papers 95-21, RAND - Labor and Population Program.
    3. 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.
    4. Gertler, Paul J. & Hammer, Jeffrey S., 1997. "Strategies for pricing publicly provided health services," Policy Research Working Paper Series 1762, The World Bank.
    5. 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.
    6. Majumder, Amlan, 2014. "Economics of health care utilisation: a study of self-reported morbidity and health seeking patterns in the districts of Cooch Behar and Jalpaiguri, West Bengal, India," EconStor Books, ZBW - Leibniz Information Centre for Economics, number 110899, May.
    7. Marion Albouy & Maud Parthenay & Maeva Nogues & Agathe Leyris & Léa Degorce & Zacharie Barthelemy & Diana Rafidison & Anne-Sophie Gourgues & Virginie Migeot & Jean Pylouster & Antoine Dupuis, 2022. "A Clinical Preventive Strategy Based on a Digital Tool to Improve Access to Endocrine Disruptors Exposure Prevention: The MEDPREVED Study," IJERPH, MDPI, vol. 19(19), pages 1-22, September.
    8. Bedi, A.S. & Kimalu, P. & Kimenyi, M.S. & Manda, D.K. & Mwabu, G. & Nafula, N., 2003. "User charges and utilisation of health services in Kenya," ISS Working Papers - General Series 19140, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    9. Ali Asgary & Ken Willis & Ali Taghvaei & Mojtaba Rafeian, 2004. "Estimating rural households’ willingness to pay for health insurance," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(3), pages 209-215, September.
    10. David E. Sahn & Stephen D. Younger & Garance Genicot, 2003. "The Demand for Health Care Services in Rural Tanzania," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 65(2), pages 241-260, May.
    11. 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.
    12. Majid S. Kermani & Hossein Ghaderi & Ayoub Yousefi, 2008. "Demand for medical care in the urban areas of Iran: an empirical investigation," Health Economics, John Wiley & Sons, Ltd., vol. 17(7), pages 849-862, July.
    13. Dr B C Purohit, "undated". "Structural Adjustment and the Health Care Sector in India: some policy issues in financing," QEH Working Papers qehwps02, Queen Elizabeth House, University of Oxford.
    14. 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.
    15. 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.
    16. Klose, Thomas, 1999. "The contingent valuation method in health care," Health Policy, Elsevier, vol. 47(2), pages 97-123, May.
    17. Johnson, Ari & Goss, Adeline & Beckerman, Jessica & Castro, Arachu, 2012. "Hidden costs: The direct and indirect impact of user fees on access to malaria treatment and primary care in Mali," Social Science & Medicine, Elsevier, vol. 75(10), pages 1786-1792.
    18. Mwabu, Germano, 1990. "Financing health services in Africa : an assessment of alternative approaches," Policy Research Working Paper Series 457, The World Bank.
    19. Germano Mwabu, 1996. "Health Effects of Market-Based Reforms in Developing Countries," WIDER Working Paper Series wp-1996-120, World Institute for Development Economic Research (UNU-WIDER).
    20. Mataria, Awad & Giacaman, Rita & Khatib, Rana & Moatti, Jean-Paul, 2006. "Impoverishment and patients' "willingness" and "ability" to pay for improving the quality of health care in Palestine: An assessment using the contingent valuation method," Health Policy, Elsevier, vol. 75(3), pages 312-328, February.
    21. 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.
    22. Charles Mulindabigwi Ruhara & Josue Mbonigaba, 2016. "The Role of Economic Factors in the Choice of Medical Providers in Rwanda," Journal of Economics and Behavioral Studies, AMH International, vol. 8(2), pages 65-78.

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