Health care policies

Key facts

• Sufficient financial resources for the government to finance the exempted services are crucial for FHC policies to contribute towards universal health coverage.
• Free health care (FHC) policies have gained popularity over the past 10 years, mostly in western Africa.
• FHC policies remove formal user fees at the point of service. They can apply to everyone for all health services, or to a selection of specific population groups or services
• While FHC policies may trigger an increase in the use of services, evidence on improved financial protection is mixed.
• Without proper targeting and monitoring, better-off population groups will benefit from FHC policies more than vulnerable population groups.

Overview

Free health care policies – or politiques de gratuité – are about removing formal user fees. The removal of fees may apply to all health services, to the primary care level, to selected population groups, to selected services for everyone, or to selected services for specific population groups characterized by medical or economic vulnerability.

Evidence about the impact of FHC policies in terms of financial protection and health service utilization is mixed. If well-designed and implemented, FHC policies can expand coverage in countries with few resources and can therefore be part of a strategy and a catalyst to move towards universal health coverage (UHC).

What is a free health care policy?

Free health care policies aim to reduce the financial barriers that people may experience when trying to access health services. They eliminate formal user fees at the point of service.

Examples of services under a free health care policy include:

• antenatal care

• assisted deliveries

• caesarean sections

• health services for children below a defined age (often 5 years)

• health services for elderly people above a certain age (often 65 years). 

These services are chosen to protect population groups deemed to be especially vulnerable, particularly low-income groups. 

Defined geographical areas or easy-to-observe socio-demographic criteria such as age, sex or pregnancy are used to determine whether a person is eligible for free health services at the point of use. This is in contrast to relying on income or another means of assessment to determine whether an individual is entitled to exemption from user fees. 

With limited budget resources to fund FHC as a way to make progress towards UHC, there are inevitable trade-offs, which lead to decisions about prioritizing particular services or population groups over others.