The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia
This study examines the impact of a fee-waiver program for basic medical services on health care utilization in Armenia. Because of the reduction in public financing of health services and decentralization and increased privatization of health care...
| Main Authors: | , , |
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| Format: | Policy Research Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2014
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2003/01/2120329/effects-fee-waiver-program-health-care-utilization-among-poor-evidence-armenia http://hdl.handle.net/10986/19164 |
| Summary: | This study examines the impact of a
fee-waiver program for basic medical services on health care
utilization in Armenia. Because of the reduction in public
financing of health services and decentralization and
increased privatization of health care provision, private
out-of-pocket contributions are increasingly becoming a
significant component of health costs in Armenia. To help
poor families cope with this constraint, the Armenian
government provided a free-of-charge basic package service
to eligible individuals in vulnerable groups, such as the
disabled and children from single parent households. Drawing
on the 1996 and 1998-99 Armenia Integrated Survey of Living
Standards (AISLS), which allows the identification of
eligible individuals under this program, the authors
estimate the impact of the fee-waiver program on utilization
of health services, particularly among the poor. Across the
two survey rounds utilization rates have indeed declined
despite comparable levels of income, and this decline has
occurred among both the poor and the rich, with average
utilization falling by 12 percent between the two surveys.
But families with four or more children, the largest
beneficiary group under the "vulnerable
population" program, have decreased their use of health
care services in a disproportionate manner-21 percent
reduction in use between the two survey rounds. This
precipitous drop in health care use by this vulnerable
group, despite being eligible for free medical services,
suggests that the program was inadequate in stemming the
decline in the use of health services. The authors further
present evidence to suggest that the free-of-charge
eligibility program acts more like an income transfer
mechanism, particularly to disabled individuals. |
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