Rethinking Universal Access to Public Health-Care: User Fees do not Necessarily Constitute the Major Barrier

Abstract

This paper is set to explain the relative importance of expanding geographical coverage of public health facilities to show that the impact of user fees on access to health-care might be over-emphasized, and thus undermine the impact due to perceptions and spatial distribution of health facilities. From a survey data of two rural districts in Tanzania, we tabulate the reasons why sick people did not consult for medical care. It is found that unlike user fees, travelling costs feature as the major
reason for not consulting. We then make further analysis by expressing travelling costs as a proportion of the cost of medical care. It is found that accessing health services involves more than 50% of the costs of medical care. It is also observed that the poor have higher degree at which a health problem is perceived to be an illness that needs the attention of a medical doctor. Consequently, they consult lees often than the non-poor. We conclude that user fees are not necessarily the barrier to accessing health-care. Reduced travelling costs and time would potentially increase ability to pay fees. Therefore, travelling time and distance have to be reconsidered in policy design.