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Does Abolishing User Fees Lead to Improved Health Status? Evidence from Post-apartheid South Africa

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  • Shinsuke Tanaka

Abstract

Whether user fees for health services should be charged or abolished for the poor has recently been debated. This study examines the impact on child health status of removing user fees in South Africa. Our main innovation is to exploit plausibly exogenous variation in access to free health care, due to the fact that black Africans under apartheid could exercise little political power and residential choice. We find substantial improvements in weight-for-age z-scores among ex ante similar children. Falsification exercises confirm no preexisting trend in the pre-reform period or no treatment effect among noneligible children in the post-reform period.

Suggested Citation

  • Shinsuke Tanaka, 2014. "Does Abolishing User Fees Lead to Improved Health Status? Evidence from Post-apartheid South Africa," American Economic Journal: Economic Policy, American Economic Association, vol. 6(3), pages 282-312, August.
    • Handle: RePEc:aea:aejpol:v:6:y:2014:i:3:p:282-312
    Note: DOI: 10.1257/pol.6.3.282
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    References listed on IDEAS

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    1. Esther Duflo, 2003. "Grandmothers and Granddaughters: Old-Age Pensions and Intrahousehold Allocation in South Africa," The World Bank Economic Review, World Bank, vol. 17(1), pages 1-25, June.
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    3. Carter, Michael R. & Maluccio, John A., 2003. "Social Capital and Coping with Economic Shocks: An Analysis of Stunting of South African Children," World Development, Elsevier, vol. 31(7), pages 1147-1163, July.
    4. Drimie, Scott & Harris, Jody, 2012. "Toward an integrated approach for addressing malnutrition in Zambia: a literature review and institutional analysis:," IFPRI discussion papers 1200, International Food Policy Research Institute (IFPRI).
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    Citations

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    Cited by:

    1. Ito, Takahiro & Tanaka, Shinsuke, 2018. "Abolishing user fees, fertility choice, and educational attainment," Journal of Development Economics, Elsevier, vol. 130(C), pages 33-44.
    2. Branson, Nicola & Byker, Tanya, 2018. "Causes and consequences of teen childbearing: Evidence from a reproductive health intervention in South Africa," Journal of Health Economics, Elsevier, vol. 57(C), pages 221-235.
    3. Yohan Renard, 2022. "From fees to free: User fee removal, maternal health care utilization and child health in Zambia," Post-Print hal-04216814, HAL.
    4. Shrestha, Vinish & Jung, Juergen, 2023. "Healthcare reform and gender specific infant mortality in rural Nepal," World Development, Elsevier, vol. 161(C).
    5. 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).
    6. Ma, Yuanyuan & Nolan, Anne & Smith, James P., 2020. "Free GP care and psychological health: Quasi-experimental evidence from Ireland," Journal of Health Economics, Elsevier, vol. 72(C).
    7. Beuermann, Diether W. & Pecha, Camilo J., 2020. "The effect of eliminating health user fees on adult health and labor supply in Jamaica," Journal of Health Economics, Elsevier, vol. 73(C).
    8. Maria Kuecken & Josselin Thuilliez & Marie-Anne Valfort, 2013. "Large-scale health interventions and education: Evidence from Roll Back Malaria in Africa," Documents de travail du Centre d'Economie de la Sorbonne 13075r, Université Panthéon-Sorbonne (Paris 1), Centre d'Economie de la Sorbonne, revised Jun 2015.
    9. Diether Beuermann & Camilo Pecha, 2016. "Healthy to Work: The Impact of Free Public Healthcare on Health Status and Labor Supply in Jamaica," IDB Publications (Working Papers) 96656, Inter-American Development Bank.
    10. Huang, Wei & Liu, Hong, 2023. "Early childhood exposure to health insurance and adolescent outcomes: Evidence from rural China," Journal of Development Economics, Elsevier, vol. 160(C).
    11. Mark Bigool, 2024. "Effects of free maternal healthcare on stunting in children under five years of age: Evidence from Ghana," Development Policy Review, Overseas Development Institute, vol. 42(4), July.
    12. 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).
    13. Jonah S. Goldberg, 2023. "What we measure when we measure the effects of user fees: a replication, reanalysis, and extension of Tanaka, 2014," Empirical Economics, Springer, vol. 65(4), pages 1981-2009, October.
    14. Steven F. Koch, 2017. "User Fee Abolition and the Demand for Public Health Care," South African Journal of Economics, Economic Society of South Africa, vol. 85(2), pages 242-258, June.
    15. Kline,Dean Mark & Sautmann,Anja, 2022. "The Effects of Community Health Worker Visits and Primary Care Subsidies on Health Behaviorand Health Outcomes for Children in Urban Mali," Policy Research Working Paper Series 9986, The World Bank.

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    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration
    • O17 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Formal and Informal Sectors; Shadow Economy; Institutional Arrangements

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