Senior Lecturer, London School of Hygiene and Tropical Medicine
Research Fellow, CGD Europe
There is an ongoing debate as to whether governments in developing countries should charge their citizens when they use public healthcare. Proponents of user fees argue that such charges generate more revenue for cash-strapped health systems and prevent over-utilisation of services. Critics point out that user fees prevent many of the poorest from seeking care when they need it the most, and increase the burden of health shocks with the cost of treatment.
In this Sandwich Seminar, Mylene Lagarde (LSHTM) presents evidence from a change in policy at the national level. In mid-2006, the Zambian government began abolishing user fees across a range of state-provided health centres. In a new paper, Lagarde and her co-authors estimate the impact of this decision using a pooled synthetic control method. They find no evidence that user fee removal changed health seeking behaviours, even among the poorest. Nonetheless, their results confirm that the policy change virtually eliminated medical expenditures, thereby providing financial protection to Zambians relying on the health system.
The CGD Europe Sandwich Seminars bring some of the world's leading development scholars to discuss their new research and ideas. The presentations aim to meet an academic standard of quality and are at times technical, and retain a focus on a mixed audience of researchers and policymakers. A light lunch is provided.