Feasibility and desirability of prepayments and in-kind payments for health care in a poor country: social illusion versus economic reality

Abstract

Prepayment and in-kind payments arc highly proposed as essential mechanisms that can relieve the poor who arc willing to contribute to the recovery of the costs of health-care services but are not able to pay cash directly at the counter. This idea is based on the experience that in poor countries like Tanzania, there is a proportion of the community who could find it easier to pay for health care before they get ill (prepayment) than doing so once they face illness. It is also concerned that, there are people who find it difficult to access cash to pay for health care while they would have been able to pay had they been allowed to dispose off some kinds of materials or provide other services other than money in cash terms in exchange for health-care services. Nevertheless, there is limited literature and analysis regarding the feasibility and practicality of such (especially in-kind) forms of payments in developing countries that are striving to introduce market principles in their health-care delivery systems. This paper provides a critical analysis regarding the theoretical desirability and actual limitations to the acceptability and practicality of both prepayment and in-kind payments in the formal health-care system of a developing country.