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...
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| Format: | Policy Research Working Paper |
| Language: | English en_US |
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World Bank, Washington, DC
2014
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| 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 |
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okr-10986-191642021-04-23T14:03:41Z The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia Chaudhury, Nazmul Hammer, Jeffrey Murrugarra, Edmundo AGED BASIC SERVICES CARDIOVASCULAR DISEASES DECENTRALIZATION DOCTORS EXPENDITURES EXTERNALITIES FAMILIES GIRLS HEALTH CARE HEALTH CARE PROVIDERS HEALTH CARE PROVISION HEALTH CARE SECTOR HEALTH CARE SERVICES HEALTH CARE UTILIZATION HEALTH COSTS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH OUTCOMES HEALTH POSTS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HOSPITAL CARE HOSPITAL UTILIZATION HOSPITALS HOUSEHOLDS ILLNESSES INCOME INTERVENTION LIVING STANDARDS MEDICAL CARE MEDICAL SERVICES MORBIDITY MORTALITY PARASITIC DISEASES PARENTS PATIENTS POLICY RESEARCH PRIMARY HEALTH CARE PROBABILITY QUALITY OF HEALTH CARE WAR VICTIMS WORKERS HEALTH SERVICES HEALTH FINANCING USER FEES SERVICE DELIVERY HEALTH SERVICE DELIVERY VULNERABLE GROUPS DISABLED PERSONS SINGLE PARENT FAMILIES CHILD HEALTH SERVICES ELIGIBILITY CRITERIA UTILIZATION FEES USER PARTICIPATION 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. 2014-07-31T22:29:01Z 2014-07-31T22:29:01Z 2003-01 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 English en_US Policy Research Working Paper;No. 2952 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank, Washington, DC Publications & Research :: Policy Research Working Paper Publications & Research Europe and Central Asia Armenia |
| repository_type |
Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
| building |
World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
English en_US |
| topic |
AGED BASIC SERVICES CARDIOVASCULAR DISEASES DECENTRALIZATION DOCTORS EXPENDITURES EXTERNALITIES FAMILIES GIRLS HEALTH CARE HEALTH CARE PROVIDERS HEALTH CARE PROVISION HEALTH CARE SECTOR HEALTH CARE SERVICES HEALTH CARE UTILIZATION HEALTH COSTS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH OUTCOMES HEALTH POSTS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HOSPITAL CARE HOSPITAL UTILIZATION HOSPITALS HOUSEHOLDS ILLNESSES INCOME INTERVENTION LIVING STANDARDS MEDICAL CARE MEDICAL SERVICES MORBIDITY MORTALITY PARASITIC DISEASES PARENTS PATIENTS POLICY RESEARCH PRIMARY HEALTH CARE PROBABILITY QUALITY OF HEALTH CARE WAR VICTIMS WORKERS HEALTH SERVICES HEALTH FINANCING USER FEES SERVICE DELIVERY HEALTH SERVICE DELIVERY VULNERABLE GROUPS DISABLED PERSONS SINGLE PARENT FAMILIES CHILD HEALTH SERVICES ELIGIBILITY CRITERIA UTILIZATION FEES USER PARTICIPATION |
| spellingShingle |
AGED BASIC SERVICES CARDIOVASCULAR DISEASES DECENTRALIZATION DOCTORS EXPENDITURES EXTERNALITIES FAMILIES GIRLS HEALTH CARE HEALTH CARE PROVIDERS HEALTH CARE PROVISION HEALTH CARE SECTOR HEALTH CARE SERVICES HEALTH CARE UTILIZATION HEALTH COSTS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH OUTCOMES HEALTH POSTS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HOSPITAL CARE HOSPITAL UTILIZATION HOSPITALS HOUSEHOLDS ILLNESSES INCOME INTERVENTION LIVING STANDARDS MEDICAL CARE MEDICAL SERVICES MORBIDITY MORTALITY PARASITIC DISEASES PARENTS PATIENTS POLICY RESEARCH PRIMARY HEALTH CARE PROBABILITY QUALITY OF HEALTH CARE WAR VICTIMS WORKERS HEALTH SERVICES HEALTH FINANCING USER FEES SERVICE DELIVERY HEALTH SERVICE DELIVERY VULNERABLE GROUPS DISABLED PERSONS SINGLE PARENT FAMILIES CHILD HEALTH SERVICES ELIGIBILITY CRITERIA UTILIZATION FEES USER PARTICIPATION Chaudhury, Nazmul Hammer, Jeffrey Murrugarra, Edmundo The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia |
| geographic_facet |
Europe and Central Asia Armenia |
| relation |
Policy Research Working Paper;No. 2952 |
| description |
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. |
| format |
Publications & Research :: Policy Research Working Paper |
| author |
Chaudhury, Nazmul Hammer, Jeffrey Murrugarra, Edmundo |
| author_facet |
Chaudhury, Nazmul Hammer, Jeffrey Murrugarra, Edmundo |
| author_sort |
Chaudhury, Nazmul |
| title |
The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia |
| title_short |
The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia |
| title_full |
The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia |
| title_fullStr |
The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia |
| title_full_unstemmed |
The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia |
| title_sort |
effects of a fee-waiver program on health care utilization among the poor : evidence from armenia |
| publisher |
World Bank, Washington, DC |
| publishDate |
2014 |
| url |
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 |
| _version_ |
1764439222533488640 |