Background: Studies conducted in developed countries using economic models show that individual-and household-level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women.

We use a quantile regression method to analyse the demand effects of user fees over the entire distribution of visits in a sample of rural and urban populations controlling for other covariates of interest, notably income and demographics. We find that the negative effects of fees on attendance differ across the visit quantiles, with the smallest effects being felt at higher quantiles. The main contribution of the paper is to show the non-uniform effects of fees at different points of the visits distribution, in contrast to the average effect computed using the OLS method. The policy implications of the findings are briefly discussed.Re´sume´: Les auteurs du pre´sent article utilisent une me´thode de re´gres-sion quantile pour analyser l'incidence des frais impose´s aux usagers des services de sante´sur la demande de soins me´dicaux, en fonction de la re´partition globale des visites effectue´es par un e´chantillon de la population rurale et urbaine, et ve´rifier d'autres co-variables importantes, telles que le revenu et la de´mographie. Ils estiment que les effets ne´gatifs des frais impose´s aux usagers sur leur fre´quentation des centres de santev arient selon le nombre de fois ou`ceux-ci se rendent dans ces centres, car plus leur taux de fre´quentation est e´leve´, plus ces effets ne´gatifs sont insignifiants. La pre´sente e´tude a pour principal objet de montrer les effets non uniformes des frais impose´s aux usagers, a`diffe´rents points de re´parti-tion de leur fre´quentation des centres de sante´, par opposition aux effets moyens calcule´s selon la me´thode OLS. Elle traite brie`vement de l'incidence des re´sultats obtenus sur les politiques ge´ne´rales.

BackgroundThere is ample evidence in Asia and Latin America showing that past economic crises resulted in cuts in expenditures on health, lower utilization of health services, and deterioration of child and maternal nutrition and health outcomes. Evidence on the impact of past economic crises on health sector in Africa is lacking. The objectives of this article are to present the findings of a quick survey conducted among countries of the WHO African Region to monitor the effects of global financial crisis on funding for health development; and to discuss the way forward.MethodsThis is a descriptive study. A questionnaire was prepared and sent by email to all the 46 Member States in the WHO African Region through the WHO Country Office for facilitation and follow up. The questionnaires were completed by directors of policy and planning in ministries of health. The data were entered and analyzed in Excel spreadsheet. The main limitations of this study were that authors did not ask whether other relevant sectors were consulted in the process of completing the survey questionnaire; and that the overall response rate was low.ResultsThe main findings were as follows: the response rate was 41.3% (19/46 countries); 36.8% (7/19) indicated they had been notified by the Ministry of Finance that the budget for health would be cut; 15.8% (3/19) had been notified by partners of their intention to cut health funding; 61.1% (11/18) indicated that the prices of medicines had increased recently; 83.3% (15/18) indicated that the prices of basic food stuffs had increased recently; 38.8% (7/18) indicated that their local currency had been devalued against the US dollar; 47.1% (8/17) affirmed that the levels of unemployment had increased since the onset of global financial crisis; and 64.7% (11/17) indicated that the ministry of health had taken some measures already, either in reaction to the global financing crisis, or in anticipation.ConclusionA rapid assessment, like the one reported in this article, of the effects of the global financial crisis on a few variables, is important to alert the Ministry of Health on the looming danger of cuts in health funding from domestic and external sources. However, it is even more important for national governments to monitor the effects of the economic crisis and the policy responses on the social determinants of health, health inputs, health system outputs and health system outcomes, e.g. health.

Medical insurance is an important feature of a health care system in which patients pay user charges to get medical treatment. Without insurance, many people would not afford acceptable care in a fee-for-service system. Since health is a merit good, making insurance broadly available in communities is a major policy issue in countries where user fees finance medical treatments. The paper analyses data from facility and household surveys in Kenya and shows that policies which popularize medical insurance can be inefficient because there exist community and household level factors that inhibit its use. The results further reveal substantial variations in the way the variables that influence the use of insurance affect different population sub-groups. In this regard, it is important to ensure that vulnerable groups in communities are not excluded from insurance schemes in which they invest. The policy value of the paper is to call attention to factors such as place of residence, gender, income, education, community institutions, transaction costs and facility quality -that hinder or facilitate use of medical insurance so that these factors can be considered when institutionalizing insurance in communities. We note that using the community as a unit of analysis in field surveys may strengthen policy conclusions usually obtained from such surveys.Résumé: L'assurance médicale constitue un élément important de tout système de soins de santé dans lequel les patients paient pour obtenir des soins médicaux. Sans assurance, de nombreuses personnes seraient dans l'incapacité de faire face aux coûts d'un système de paiement à l'acte. La

In their article, Daily and Ehrlich have discussed a number of important recent trends associated with development and global change that appear to be reducing health security. Besides their immediate epidemiological implications, most issues raised in the paper have economic implications. However, from the point of view of the methodology of economics, despite the paper's being illuminating on the issues discussed, the immediate notable aspect is the lack of a model or framework with/within which those issues are being analysed. Indeed, it is very hard to think of a single framework which would be all-encompassing enough to be applicable to the analysis of all the issues raised in the paper. But I submit that these issues can be adequately addressed and analysed using the rather simplistic model of production and consumption,1 which is the core of all economic analysis. In what follows, I will pick only a few of the issues raised in the paper and put them within the context of this basic economic model, so as to examine their economic implications.