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Did primary healthcare user fee abolition matter? Reconsidering South Africa's experience

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  • Anna S Brink
  • Steven F Koch

Abstract

South Africa waived user fees for primary healthcare in 1994 and, again, in 1996. The first waiver focused on young children, elderly adults, pregnant women and nursing mothers, while the 1996 reform waived fees for the remainder of the population, subject to means tests. We take advantage of household survey information to examine the impact of the policy on a subset of the reform-eligible population. Although it was expected that public healthcare facility usage would have increased post reform, no statistically significant evidence supported such a claim. Therefore, our results are consistent with some very recent research examining the 1994 reform, but are generally at odds with the general impression in the literature that user fee abolition matters when it comes to alleviating inequities in access to healthcare.

Suggested Citation

  • Anna S Brink & Steven F Koch, 2015. "Did primary healthcare user fee abolition matter? Reconsidering South Africa's experience," Development Southern Africa, Taylor & Francis Journals, vol. 32(2), pages 170-192, March.
    • Handle: RePEc:taf:deveza:v:32:y:2015:i:2:p:170-192
    DOI: 10.1080/0376835X.2014.984373
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    Cited by:

    1. Steven F Koch & Naomi Setshegetso, 2020. "Catastrophic health expenditures arising from out-of-pocket payments: Evidence from South African income and expenditure surveys," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-14, August.
    2. Steven F. Koch & Jeffrey S. Racine, 2016. "Healthcare facility choice and user fee abolition: regression discontinuity in a multinomial choice setting," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(4), pages 927-950, October.
    3. Steven F. Koch & Naomi Setshegetso, 2021. "Progressivity of out-of-pocket payments and its determinants decomposed over time," Development Southern Africa, Taylor & Francis Journals, vol. 38(5), pages 731-749, September.
    4. 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.

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