The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia

Chaudhury, Nazmul ; Hammer, Jeffrey ; Murrugarra, Edmundo

World Bank, Washington, DC

关键词: AGED;    BASIC SERVICES;    CARDIOVASCULAR DISEASES;    DECENTRALIZATION;    DOCTORS;   

DOI  :  10.1596/1813-9450-2952
RP-ID  :  WPS2952

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

This study examines the impact of afee-waiver program for basic medical services on health careutilization in Armenia. Because of the reduction in publicfinancing of health services and decentralization andincreased privatization of health care provision, privateout-of-pocket contributions are increasingly becoming asignificant component of health costs in Armenia. To helppoor families cope with this constraint, the Armeniangovernment provided a free-of-charge basic package serviceto eligible individuals in vulnerable groups, such as thedisabled and children from single parent households. Drawingon the 1996 and 1998-99 Armenia Integrated Survey of LivingStandards (AISLS), which allows the identification ofeligible individuals under this program, the authorsestimate the impact of the fee-waiver program on utilizationof health services, particularly among the poor. Across thetwo survey rounds utilization rates have indeed declineddespite comparable levels of income, and this decline hasoccurred among both the poor and the rich, with averageutilization falling by 12 percent between the two surveys.But families with four or more children, the largestbeneficiary group under the "vulnerablepopulation" program, have decreased their use of healthcare services in a disproportionate manner-21 percentreduction in use between the two survey rounds. Thisprecipitous drop in health care use by this vulnerablegroup, despite being eligible for free medical services,suggests that the program was inadequate in stemming thedecline in the use of health services. The authors furtherpresent evidence to suggest that the free-of-chargeeligibility program acts more like an income transfermechanism, particularly to disabled individuals.