This research aimed to understand the equity implications of prepayment and discount cards relative to the user charges system they sought to improve. The paper proposes simple models predicting the roles of income, perceived health status, perceived quality of care and time preference in choice of payment mechanism and subsequent use of health services. It then tests these models using three data sets that could be accessed or collected: the Living Conditions Monitoring Survey conducted in 1998 in Zambia, routine health centre records and an outpatient survey designed for the purpose of this research. It is concluded that relative to user charges, prepayment facilitates access to care without incurring income related equity losses. Evidence concerning discount cards was weaker.
Health Economics, 16 (12), 1371-1387 pp. [doi: 10.1002/hec.1219]