Are people willing and able to pay for health services?
Yoder, R.A.
Social Science and Medicine 29(1): 35-42
1989
ISSN/ISBN: 0277-9536 PMID: 2740926 DOI: 10.1016/0277-9536(89)90125-1Document Number: 361961
Following a nationwide increase in user fees for health services in Swaziland, the paper analyses the effect of the fee increase on overall patient use of health services, on types of services (curative versus preventive) and on changes in utilization by higher and lower paying groups. Patient attendance data from a 71% sample of government and mission health facilities suggests that the 'people are willing and able to pay for health services' assertion is not supported by the Swaziland case since most of the predominantly rural population is poor. Following the fee increase, average attendance decreased at government facilities by 32.4% and increased at mission facilities by 10.2%, leading to a combined decline of around 17%. This indicates that some mission facilities are being substituted for some government facilities. In addition, the existence of over 5000 traditional healers in Swaziland along with estimates indicating that the rural 85% of the Swazi population use traditional healers at least once per year, suggests that traditional health services may also be substituted for modern health services. Patient visits designed to protect against childhood diseases, BCG and DPT immunizations, or against dehydration in children, show average attendance declines of 16%, 19% and 24% respectively, while visits for musculoskeletal diseases, a less serious disease, declined 1.2%. The analysis also suggests that up to 34% of the overall decline in attendance was among patients who previously had paid the least for health care with part of this decline including fewer multiple visits.
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