Uganda's experience with abolishing user fees.
Economic and welfare impact of the abolition of health user fees: evidence from Uganda
Abolishing health user fees improved both health and economic status of the poor in Uganda
Authors:
K. Deininger; P. Mpuga
Publisher:
Policy Research Working Papers, World Bank, 2003
This working paper, published by the World Bank, explores the impact of the abolition of user fees for public health services, using household data from Uganda. It finds that the policy change improved access and reduced the probability of sickness in a way that was particularly beneficial to the poor. Due to reductions in the amount of time spent ill, there were also economic benefits, and these were similarly concentrated among the poor. Although the challenge of maintaining quality remained, the overall benefits were estimated to be significantly larger than the loss of revenue due to the abolition of user fees.
The paper suggests that the improvements which followed the abolition of user fees may be partly due to other policies brought in at the same time: health sector funding was increased, and measures to increase the supply of health services were put in place. It argues that this illustrates the benefits of an approach that removes obstacles to health services in a coordinated way. In order to maintain these gains, the paper recommends the establishment of a system to monitor, publicise, and reward the quality of service delivery. It concludes by arguing that both market and non-market incentives are needed to maintain and improve the quality of care.
