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Waivers and exemptions for health services in developing countries

Author

Listed:
  • Bitran, Ricardo
  • Giedion, Ursula

Abstract

In response to shortages in public budgets for government health services, many developing countries around the world, have adopted formal, or informal systems of user fees for health care. In most countries, user fee proceeds seldom represent more than 15 percent of total costs in hospitals, and health centers, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial, or full waivers to the poor, often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees, compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed, and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence, than countries that have improvised such systems (Ghana, Kenya, Zimbabwe). Key to the success of a waiver system is its financing. Systems that compensate providers for the revenue forgone from granting exemptions (Thailand, Indonesia, and Cambodia) have been more successful than those who expect the provider to absorb the cost of exemptions (Kenya). Where waiver system exist, performance will improve with the timeliness of the reimbursement. Other success factors include the widespread dissemination among potential beneficiaries, about waiver availability, and procedures; the awarding of financial support to poor patients for non-fee costs of care, such as food and transportation (as in Cambodia); and, the existence of clear criteria for the granting of waivers, thereby reducing confusion, and ambiguity among those responsible for managing the system, and among potential recipients. The review examines various approaches taken by countries, but assessing their relative practical merits is difficult, as the evidence is scattered and mixed.

Suggested Citation

  • Bitran, Ricardo & Giedion, Ursula, 2003. "Waivers and exemptions for health services in developing countries," Social Protection Discussion Papers and Notes 25987, The World Bank.
  • Handle: RePEc:wbk:hdnspu:25987
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    Citations

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    Cited by:

    1. World Bank, 2006. "Making the New Indonesia Work for the Poor," World Bank Publications - Reports 8172, The World Bank Group.
    2. Ridde, Valéry & Yaogo, Maurice & Kafando, Yamba & Kadio, Kadidiatou & Ouedraogo, Moctar & Bicaba, Abel & Haddad, Slim, 2011. "Targeting the worst-off for free health care: A process evaluation in Burkina Faso," Evaluation and Program Planning, Elsevier, vol. 34(4), pages 333-342, November.
    3. Palmer, Michael G. & Nguyen, Thi Minh Thuy, 2012. "Mainstreaming health insurance for people with disabilities," Journal of Asian Economics, Elsevier, vol. 23(5), pages 600-613.
    4. Emma Aguila & Mariana López-Ortega & Luis Miguel Gutiérrez Robledo, 2018. "Non-contributory pension programs and frailty of older adults: Evidence from Mexico," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-19, November.
    5. Ensor, Tim & Ronoh, Jeptepkeny, 2005. "Effective financing of maternal health services: A review of the literature," Health Policy, Elsevier, vol. 75(1), pages 49-58, December.
    6. Aran, Meltem A. & Hentschel, Jesko S., 2012. "Protection in good and bad times ? the Turkish green card health program," Policy Research Working Paper Series 6178, The World Bank.
    7. repec:ilo:ilowps:375955 is not listed on IDEAS
    8. Kelvin Swere, 2016. "Challenges Hindering the Accessibility of Tanzania’s Health Service: A Literature Review," International Journal of Economics and Finance, Canadian Center of Science and Education, vol. 8(8), pages 242-242, August.
    9. 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.
    10. Hadley, Mary, 2011. "Does increase in utilisation rates alone indicate the success of a user fee removal policy? A qualitative case study from Zambia," Health Policy, Elsevier, vol. 103(2), pages 244-254.

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