Does Free Public Health Care Increase Utilization and Reduce Spending? Heterogeneity and Long-Term Effects
Does Free Public Health Care Increase Utilization and Reduce Spending? Heterogeneity and Long-Term Effects
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DOI：
10.1016/j.worlddev.2017.05.040
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发表时间：
2018-01-01
影响因子：
6.9
通讯作者：
Aakvik, Arild
中科院分区：
文献类型：
--
作者：
Hangoma, Peter;Robberstad, Bjarne;Aakvik, Arild
2006年，赞比亚在72个县中的54个县取消了公共支助的政府和宗教保健设施的使用费。2007年，这项工作扩大到以前未受影响的县的农村地区。逐步实施的搬迁政策和五波全国代表性的家庭调查数据提供的自然实验，使我们能够研究搬迁政策对利用和家庭健康支出的影响。我们发现，该政策在短期内增加了卫生服务的整体利用，其影响在长期内是持续的。对于户主失业或没有受过教育或受教育程度较低的个人，增幅更高。该政策还导致寻求护理的人从私人护理机构转向公共支助的护理机构，这主要是由户主有正式工作或从事农业的个人推动的。产生任何支出的可能性降低，尽管从长期来看略有减弱。与此同时，有条件的卫生支出有上升的压力，即，在扣除那些有任何开支的人士的费用后，开支较高。因此，家庭卫生总支出（无条件）没有受到显著影响。(C)2017作者（S）爱思唯尔有限公司出版
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. (C) 2017 The Author(s). Published by Elsevier Ltd.