Equity Shortfalls & Failure of The Welfare State: Community Willingness to Pay for Health Care at Government Facilities in Jehlum (Pakistan)
AbstractBackground: The question of willingness to pay is very crucial in planning for services. In Pakistan, the long-term issues of sustainability of health systems particularly, allocation of finances have routinely been addressed by planners with insufficient data and unclear goals. This study was conducted with the objectives to determine the demand for health care services in the community; at first level care facilities and community level and determine the willingness of the community (Willingness to pay) to participate in cost sharing mechanisms for provision of primary health care in fee for service and prepayment mechanisms. Methods: A cross sectional stratified household interview survey of 600 households was carried out in urban and rural areas of district Jehlum, to address the financial sustainability of government health care interventions at the community level and to explore the question of willingness to pay for health care and their ability to participate in the cost sharing mechanisms. Results: In response to willingness to pay at a Government facility to obtain health care 437 (72.7%) of the households expressed their willingness to pay for health care. In 72% of the cases, cost was not considered as a barrier in seeking care and only 19% of the cases considered cost as a partial barrier; the rest said that cost prohibited seeking care. A majority across all strata is willing to pay for consultation and medicines at public sector facilities, although the responses from the low income groups exhibit a slight decrease in the willingness to pay. The willingness to pay is marginally affected by income, place of residence and/or cost of the treatment incurred. Conclusion: The findings of this study suggest that the community is willing to pay for health care at the public sector facilities if payment can ensure provision of essential curative services and medications at improved quality levels.Key Words: Health Expenditures, Equity, Cost sharing, Health Services Needs and Demands
Welch C. Structural Adjustment Programs and Poverty Reduction Strategies, Foreign Policy in Focus (www.fpif.org) vol 5 no 14 September 2001
World Development Report, Investing in Health, World Bank, 1993,
Cavanagh J, Welch C, Retallack S. The IMF Formula: Prescription for Poverty IFG Bulletin, Volume 1, Issue 3, International Forum on Globalization, 2001,
World Health Report 2000, Improving Health Systems Performance WHO 2000
Macroeconomics and Health: Investing in Health for Economic Development. Report of the Commision on Macroeconomics and Health WHO 2001
Ministry of Health, Government of Pakistan, National Health Policy, 1997
Ministry of Health, Government of Pakistan, National Health Policy, The way forward, 2001
UNICEF, State of the Worlds Children, 1999
Richard A. Yoeder, Are People Willing and Able to Pay for Health Services?, Soc Sci Medicine 1989;29(1):24-6.
Ministry of Health, Second Evaluation Report, Prime Minister's Programme for Family Planning and Primary Health Care, Primary Health Care Cell, 1995-96
Primary Health Care Cell, Ministry of Health, Health For All By the Year 2000: Third Evaluation Report. 1997
World Development Report: Investing in Health 1993, World Bank
Kanji N. Charging for drugs in Africa: UNICEF's Bamako Initiative. Health Policy and Planning;1989:4(2):89-91.
Diop F, Yazbeck A, Bitran R.The impact of alternative cost recovery schemes on access and equity in Niger, Health Policy and Planning 10 (3) 1995
Wouters A. Improving quality through cost recovery in Niger, Health Policy and Planning 10(3), 1995
Shaw RP, Griffin CC. Financing Health Care in Sub Saharan Africa through user fees and Insurance, World Bank, 1995
Gilson L. The lesson of User fee experience in Africa, Health Policy and Planning, 12(4), 1997
Yoeder RA, Lalani S, Makinen M. Policy options for Financing Health Services in Pakistan, Volume V, Organizing and Financing Rural Health Services, 1993
Latwick JI, Bodart C. User Fees Plus Quality Equals Improved Access to Health Care: Results of a Field Experiment in Cameroon. Soc Sci Med 1993;37 (3):34-9
Pakistan Towards a Health Sector Strategy. Health Nutrition and Population Unit, South Asia Region. World Bank 1998
Planning Commission, Government of Pakistan, 8th Five Year Plan, 1993-98
Pakistan Integrated HouseHold Survey (1995-96) Access and usage of basic health care in Pakistan. Federal Bureau of Statistics. Government of Pakistan 1996
Economic Survey of Pakistan 2001-02, Economic Advisors Wing, Government of Pakistan 2001
Pakistan-2010 Programme, (issued 1997) Ministry of Planning and Development. Government of Pakistan
Human Development Report 1998, United Nations Development Program, 1998
Government of Pakistan, Statistics Division, Population Census Organization 1998, Provisional Results of the Fifth Population and Housing Census Held in March, 1998
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