The Impact of User Fees on Health Care Utilisation: Evidence from a Policy Experiment

Abstract: In this paper, we examine the impact of changes in the fees that patients pay when they use primary health care services on the utilisation of these services, as well as the flow-on impact on utilisation of secondary care services and on health status. Unlike the situation in many other OECD countries, the New Zealand government has traditionally provided only partial subsidies to support access to primary health care services, leaving New Zealanders to pay for much of their own primary health care through fee-for-service user charges paid to primary health care practitioners. It was widely felt that these fees have resulted in significant barriers to access to care, especially for those on lower income, thus, in 2001, the government began to implement the Primary Health Care Strategy (PHCS), which aimed to improve access to primary health care services, to improve health and to reduce inequalities in health.