The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence?
Mylene Lagarde, Natasha Palmer
Volume 86, Number 11, November 2008, 839-848
Table 10. Effects of increasing user fees on health service utilization in low- and middle-income countries, according to literature review
| Study | Outcome measure | Percent variation in fee | Reanalysis for the systematic review |
Conclusions presented in the original study | ||||
|---|---|---|---|---|---|---|---|---|
| Percent change in intervention area(s) | “Absolute” elasticity | Percent change in control area(s) | Percent change in intervention areas | “Relative” elasticity | ||||
| Issifou & Kremsner (2004) |
Number of outpatient visits | +66 | –47.4*** | –0.7 | –13.3 | –34.1 | –0.5 | Drop in use in both cases |
| +20a | –44.5*** | –2.2 | +26.9 | –71.4 | –3.6 | |||
| Bratt et al. (2002) |
Average number of visits to obsetrician-gynaecologist | +35.6 | –22.5 | –0.63b | –16.7 | –5.8 | –0.32c | Decrease in use but inelastic demand (for all cases) |
| +53.5 | –25.9 | –0.48b | 16.7 | –9.3 | –0.26c | |||
| Average number of prenatal visits | +36.9 | –5.0 | –0.14b | –3.0 | –2.0 | –0.10c | ||
| +54.6 | –13.4 | –0.25b | –3.0 | –10.4 | –0.28c | |||
Significance levels (computed for the review when possible): ***P < 0.001.a The second increase of 20% took place after the first increase of 66%.b Unlike Bratt et al.30 who computed arc elasticities using the “mid-point technique”, arc elasticities were recomputed using the following formula: (QF–QI) / QI / (PF–PI) / PI, to use a coherent method throughout the review.c Control areas experienced changes in price as well, even though they were less important: +17.4% for visits to obstetrician-gynaecologist, +17% for prenatal visits, +18.5% for intrauterine device (IUD) insertions and +17.5% for IUD revisits.
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