Did primary health care user fee abolition matter? Reconsidering South Africa’s experience

Abstract

South Africa waived user fees for primary healthcare in 1994 and, again, in 1996. The first waiver focused on young children, elderly adults, pregnant women and nursing mothers, while the 1996 reform waived fees for the remainder of the population, subject to means tests. We take advantage of household survey information to examine the impact of the policy on a subset of the reform-eligible population. Although it was expected that public healthcare facility usage would have increased post-reform, no statistically significant evidence supported such a claim. Therefore, our results are consistent with some very recent research examining the 1994 reform, but are generally at odds with the general impression in the literature that user fee abolition matters, when it comes to alleviating inequities in access to healthcare.