User fees : Determining people's ability and willingness to pay for Health Care - A comparative study between Public and Private health sectors in Lusaka Urban.

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Mutati, Margaret M.
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User fees in Lusaka, Zambia, were introduced in government health care facilities, in August 1993, with the overall aim of providing Zambians with equity of access to cost effective quality health care as close to the family as possible. The introduction of user fees was based on the assumption that households are able and willing to pay for health care. This study aims to determine households' willingness and ability to pay for health services in public and private health care sectors in Lusaka urban. Once determining factors are identified measures intended to provide policy makers with data for enhancing the design of the scheme can then be recommended. A cross-sectional study was conducted in Lusaka, during the months of October to November 1996. Using a three stage sampling procedure for identifying participants in the study, a total of 252 patients were interviewed. The study revealed the following :72.2%(n=252) of the households had the ability to pay based on the pre-set criteria, with 76.6% indicating that the current fees being charged in the public sector were affordable. About 60% indicated that with their current incomes they were able to access health services in the public sector. Of the 252, 64.7% were members of the University Teaching Hospital medical scheme, an insurance scheme for households. In order of importance, the main determinants of health care choices were distance (57.9%), quality of service (42.9%), and cost (16.7%). The findings suggest that in the population studied, cost was not a critical determinant.However, comparing various treatment outlets, findings are that 86.5% attended government health services because they were nearest to their homes as compared to 1 (1.9%) of those attending traditional healers. The study population defined good care in public and private sectors in terms of availability of drugs (78.6%), staff attitude (52.8%) and technical competence (40.1%). However, among the traditional healers patients did not consider technical competence as being important. Although the majority of households were able to pay, there remained about 29.5% of the households who were unable to pay for health care, which raises an equity problem. A majority of the patients had come to accept user fees (60.7%) in public health facilities on condition that the government improved the drug situation and health staff attitudes. The medical scheme which would have provided a safety net for the poor is not known among the majority of people. In conclusion, the study revealed that more than two thirds of the population interviewed were able and willing to pay, and that good quality health services, as perceived by patients, is drug availability and good staff attitudes. With these in place many more would be willing and able to pay for health services. Based on the findings of the study, it is recommended that:- (a)The Government identifies the factors contributing to the shortage of drugs in health facilities, with the view of introducing measures to improve the situation. (b)Care should be taken to focus on improving staff attitudes, through various incentives and training. (c)Attempts should made to provide adequate information on the operations of medical scheme. (d)There is an urgent need to spell out exemption policy and maintenance of equity.
Health facilities , Health care