User Fee Abolition in South Africa in 1994 and 1996: Differences-in-Differences

Working paper 430
Author(s): 
Anna S. Brink and Steven F. Koch
Publication date: 
May, 2014
Journal: 
Development Southern Africa
Classification-JEL: 

South Africa waived user fees for primary health care, first in 1994, and again, in 1996. Since the 1994 plan focused on young children and older adults, as well as pregnant and nursing mothers, the 1996 change, which waived fees for the remainder of the population, subject to means tests, can be examined via differences-in-differences (DD). DD is applied to a subsample of children, underpinned by a multinomial logit regression of health-seeking behavior amongst ill and injured children. Although the policy provided free primary care to all at public clinics, the results of the analysis do not support the hypothesis that free primary care significantly increased public clinic visits amongst ill and injured children. However, there is strong evidence that ill and injured children were more likely (by 6%) to seek at least some sort of treatment following the change in policy, implying that the policy was indirectly successful.

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