Income versus Non-Income Barriers to Allopathic Health Care: Limits to Subsidies
Abstract
This paper studies non-income barriers to allopathic health care and considers possible scenarios for subsidy allocation to alleviate the consequent effects on access to public health care. A simple theoretical model is used to derive the effect of non-income barriers to health care and use data from Tanzania to carry out empirical verifications.
The results show that access to health care depends on both household income and non-income barriers. Knowledge about the benefits of allopathic health care is crucial in the decision to seek medical care. Information gaps on the benefits of health care system affect choice of providers of medical care. The effect is disproportionately distributed between the least and the relatively more informed households. Also, uniform subsidies in health care tend to favour those with proper knowledge of causes of disease episodes and benefits of allopathic health care. Thus, design of subsidies could reflect the effect of information gaps in order to reduce price sensitivity in charged public health care. However, it might be tedious to compute levels of subsidies by households, but regional indices of information gaps could help to design an effective subsidy scheme in public health care.
References
Akin, J., C. Griffin, D. Guilkey, & B. Popkin. 1985. The Demand for Primary Health services in the Third World. Totowa, N.J: Rowan and Allenheld.
Besley, T. 1988. A Simple Model for Merit Good Arguments. Journal of Public Economics, 35 (2): 371-383.
Besley, T. 1991. Welfare Improving User Charges for Publicly Provided Goods.
Besley, T., & S. Coate. 1991. Public Provision of Private Goods and The Redistribution of Income. American Economic Review, 81: 979-984.
Bonu. S., M. Ran, & D. Bisha. 2003. Using Willingness to pay to investigate regressiveness of user fees an health facilities in Tanzania. Health Policy and Planning; 18(4): 370-382. Oxford University Press, UK.
Donaldson, C. 1990. Willingness-to-pay for publicly provided goods: A possible measure of benefits. Journal of Health Economics, 12: 103-118.
Evans, R., & A. Wolfson. 1980. Faith, Hope and Charity: Health Care in the Utility Function. Discussion Paper No. 80-46, Department of Economics, University of British Columbia, Vancover.
Feldman, R., & B. Dowd. 1993. What Does the Demand Curve for Medical Care Measure? Journal of Health Economics, 12: 193-200.
€”. 1993. A New Estimate of the Welfare Loss of Excess Health Insurance. American Economic Review 81:297-301.
Folland, S., C. Goodman, & M. Stano. 1997. The Economics of Health and Health Care. Second Edition. Simon and Schuster, Upper Saddle River, New Jersey.
Frederic, I. 1998. Health in rural Tanzania: The determinants of health status, health-care demand and health care choice. Discussion Paper Series (DPS) 98.03. Departement Economie, Katholieke Universiteit, Leuven.
Gertler, P., & J. Van ger Gaag, 1990. The Willingness-to-pay for Medical. Baltimore and London.
Gilson, K., M. Alilio, & K. Heggenhougen. 1994. Community satisfaction with primary health care Services: An evaluation undertaken in the Morogoro region of Tanzania. Social Science and Medicine, 39: 767-780.
Gilson, L. 1992. Value for Money? The Efficiency of Primary Health Facilities in Tanzania. PhD thesis, University of London.
Griffin, C. 1992. Welfare Gains from User Charges for Government Health Services. Health Policy and Planning, 7 (2): 177-180.
Heller, P. 1982. A Model of the Demand for Medical and Health Services in Peninsular Malaysia. Social Science and Medicine, 16: 267-284.
Hongoro, C., & S. Chandiwana, 1994. The Effects of Enforcement of User Fees on the Health-Care Delivery System in Zimbabwe. A study financed by UNICEF Harare. Harare Blair Research Laboratory and Ministry of Health and Child Welfare.
Husein A.K., & P.G.M. Mujinja. 1997. Impact of user charges on government health facilities in Tanzania, East African Medical Journal, 74 (12): 751-757.
Ilse, F. 1998. Health in Rural Tanzania: The determinants of health status, health-care demand and health care choice. Discussion Paper Series (DPS) 98.03. Department Economie, Katholieke Universiteit, Leuven.
Kamuzora, P. & R. Mhamba. 1998. Health Services Provision at Local Level in the Context of Health-Sector Reform in Tanzania. A research report submitted to the joint research committee, ENRECA, University of Dar es Salaam.
Kenneth, L., & G. Mlinga. 2000. Bypassing Heath Centres in Tanzania: Revealed Preferences for Quality. A Conference Paper, April 2000, CSAE, University of Oxford.
Kiyofumi, T. 2000. Medical Anthropological Study in Western Kenya and its Implications for Community Health Development. International Development Centre of Japan, Tokyo Japan.
Leonard, K., & L. David. 1998. Institutional Solutions to the Principal Agent Problem in African Health Care. Discussion Paper Series No. 9899-09, October 1998. Department of Economics, Columbia University.
Leornad, K., & G. Mlinga. 2000. Bypassing Health Centre in Tanzania: Revealed Prferences for Quality. A Conference Paper, April 2000, CSAE, University of Oxford.
Litvack, J., & C. Bodart. 1993. User Fees Plus Quality Equals Improved Access to Health Care: Results of a field Experiment in Cameroon. Social Science and Medicine, 37: 369-83.
Mbelle, A. 1991. Implications of Imposing `Realistic ' User Charges for Public Sector Services on the Household in Tanzania. A Paper presented at a SIDA Socio-Economic Group Discussion in May 1991.
Mbugua, J.K., G.H. Bloom, M.M. Segall. 1995. The Impact of User Charges on Vulnerable Groups: The Case of Kibwezi in Rural Kenya. Social Science and Medicine 1995; 41(6): 829-835.
McGuire, A., J. Henderson, & M. Gavin. 1988. The Economics of Health Care. London and New York: Routledge and Kegan Paul.
Mushi, D.P. 1996. Cost Sharing in Health Services in Tanzania: Preliminary Impact on Quality, Affordability and Accessibility. A Case Study of Selected Regions. Research report submitted to CDR-Copenhagen and the Economic Research Bureau, University of Dar es Salaam.
€”. 2004. Fees at the Dispensary Level in Tanzania: Is Universal Access Compromised? Research Brief, Formative Research on Local Government in Tanzania, REPOA Publication Series.
€”. 2004. User Fees and Quality of Health Services: Quid Pro Quo or Deterrence; The African Journal of Finance and Management, Vol. 12 No2, 2004.
€”. 2004. User financing of public Health care: Does willingness Imply Ability to Pay? Journal of Population Studies and Development.Vol.[!?]
Mushi, D.P., L.A. Msambichaka, & G.D. Mjema. 2003. Assessment of Exemptions and Waivers on Cost Sharing Revenue Collection in Public Health Services, Consultancy Report Submitted to the Ministry of Health Tanzania, November 2003.
Mwabu, G., J. Mwanzia, & W. Liambila. 1995. User Charges in Government Health Facilities in Kenya: Effects on Attendance and Revenue. Journal of Health Policy and Planning, 10 (2): 164-70.
Smith, B. and Rawal, P. (1992). Health Sector Financing Study for the Government of Tanzania. Report on the Potential for Cost Sharing - First Report.
Stanton, B. and Clemence, J. (1989), "User Fees for Health Care in Developing Countries: A Case Study of Bangladesh". Journal of Social Science and Medicine, 29: 1199-1205.
Stoddart, G. and Baker, M. (1981), "Analysis of Demand and Utilization Through Episodes of Medical Services" in Van der Gaag, J., J., and Perman, M. (eds.), Health, Economics, and Health Economics. Amsterdam, North-Holland.
Waddington, C. and Enyimayew, K. (1989), "A price to pay: the impact of user charges in Ashant-Akin District, Ghana". Journal of Health Planning and Management 4: 17-47.
Wedig, G. (1988), Health Status and the Demand for Health. Journal of Health Economics, 7:151-163.