In the short-run, at least one factor of production is fixed, so firms face both fixed and variable costs. Economists call these costs opportunity costs, and they form a central element of economic … In environmental economics, marginal cost is broken down... See full answer below. Ranson MK, Sinha T, Morris SS, Mills AJ. User fees refer to a financing mechanism that has two main characteristics: payment is made at the point of service use and there is no risk sharing. Gilson L, McIntyre D. Removing user fees for primary care in Africa: the need for careful action. This fundamental cost is usually referred to as opportunity cost. Total cost refers to the total expense incurred in reaching a particular level of output; if such total cost is divided by the quantity produced, average or unit cost is obtained. Some have argued that user charges can generate vital resources at the local level and help provide good quality services;3–5 others have highlighted their negative effects, particularly on equity;6–9 Recently, several international campaigns have advocated the removal of user fees, especially for primary care services.1,10. User cost refers to the expenses borne by the owner or renter of a capital asset resulting from the use of the asset for a given period of time. Even studies that have been highly influential and often quoted4,29 failed our quality appraisal. A range of utilization measures were reported as outcomes, including new visits, registrations, weekly/quarterly/monthly attendance, outpatient and/or inpatient attendance. For a consumer with a fixed income, the opportunity cost of purchasing a new domestic appliance may be, for example, the value of a vacation trip not taken. This review aimed to assess the effect on health service utilization of introducing, removing, increasing or decreasing user fees in low- and middle-income countries. As the rate of interest / discount rate increases, so does MUC. What Does Total Cost Mean? Marginal cost is defined as the cost incurred by producing one more unit of a product or service. Effects of increasing user fees on health service utilization in low- and middle-income countries, according to literature review. Yoder RA. One study. External costs are directly associated with producing or delivering a good or service, but they are costs that are not paid directly by the producer. http://www1.worldbank.org/devoutreach/march04/. Evidence from carefully designed impact evaluations should be advocated, and the recent effort of the Centre for Global Development to establish an International Initiative for Impact Evaluation is to be welcomed. Numerous studies have also quantified the economic cost that smoking imposes on society. Be on the lookout for your Britannica newsletter to get trusted stories delivered right to your inbox. Hutton G. Is the jury still out on the impact of user fees in Africa? Present Value of MUC are equal over time. Sauerborn R, Nougtara A, Latimer E. The elasticity of demand for health care in Burkina Faso: differences across age and income groups. Although growth in service uptake was often greater after the policy change, suggesting potential positive outcomes in the long run, this was not a statistically significant result. However, there remains considerable scope for improvement in the quality of research and analysis around this area. Only experimental or quasi-experimental study designs were included – cluster randomized controlled trials (C-RCTs), controlled “before and after” (CBA) studies and interrupted time series (ITS) studies (Table 1) – as suggested by the Effective Practice and Organisation of Care (EPOC) group of the Cochrane Collaboration, where this review was registered. Good impact evaluations seem difficult to apply to health systems. Total cost is graphed with output quantity on the horizontal axis and dollars of total cost on the vertical axis. The scope of the review was wide. Average Cost of Service (ACS) Average Cost of Service (ACS) is another important SaaS metric for finance to track and to educate the company about. Sixteen studies met our inclusion criteria. Again, the quality of the data and analysis from which these conclusions were drawn was judged to be low. A similar problem in two experimental studies was that high inflation may have confused the effects of price variations.28,30 A key problem for the CBA studies was non-equivalence between control and intervention sites (Table 3 and Table 4). Bennett S. The impact of the increase in user fees: a preliminary investigation. Thus, if you are attending any economics classes, youll most likely have to to calculate marginal cost at some point. The transaction costs of In economics and related disciplines, a transaction cost is a cost in making any economic trade when participating in a market. MUC stands for Marginal User Cost (resource economics). Eight studies examined the effect of introducing user fees: two CBA studies,4,29 one C-RCT32 and five ITS studies.20–24 ITS studies suggested that policies that introduced user fees decreased health service uptake (Table 8). Economics 230a Fall 2011 Derivation of the User Cost of Capital Consider a firm wishing to maximize its value at date t, (1) t s r s t V t e X ds ( ), where r is the discount rate that applies to the corporation’s real activities and X s is the firm’s cash flow at date s from these activities, (2) X p F K q I k D s u q u I u du s Some recent articles have underlined the paucity of evidence on the effectiveness of policy interventions in low-income countries; We searched 25 databases covering the social science, economics and health literature. 5. In a basic economic sense, cost is the measure of the alternative opportunities foregone in the choice of one good or activity over others. User fees can entail any combination of drug costs, supply and medical material costs, entrance fees or … This abrupt increase was rarely followed by a sustained increase in utilization growth. User charges and utilisation of obstetric services in the National Capital District, Papua New Guinea. Yet, a shortage of resources at the facility level is a contributor to failure to deliver quality services, and this also presents a barrier to access. Effects of reducing user fees on health service utilization in low- and middle-income countries, according to literature review, Table 10. Economics is the study of how people allocate scarce resources for production, distribution, and consumption, both individually and collectively. Yet, the opportunity forgone is the time spent walking which could have been used instead for other purposes … Evidence from two studies28,31 on the effect of decreasing fees suggested an increase in utilization (Table 9). It is also important to stress the value of many studies that were not included in this review because they were not designed to offer a direct measure of effect, such as studies on health-seeking behaviour7,40,41 or benefit-incidence analyses.42 Recently, several developments have emerged that translate the principles of systematic reviews into health-system research, while assessing qualitative and quantitative evidence43 or accounting for the complexity of interventions.44 In the user-fee case, such complexity is demonstrated by the desirability of studying utilization, equity, quality and implementation simultaneously to really understand effect. In addition, to provide more comparable results, we computed price elasticities (ep) for studies reporting changes in user fees, and “net” elasticities for those with a control site. What factors should be taken into account when setting royalties to accurately reflect marginal user costs of nonrenewable resource extraction? These quality shortcomings, in combination with such a limited number of studies on each topic, mean that many questions remain. Dixon-Woods M, Bonas S, Booth A, Jones DR, Miller T, Sutton AJ, et al., et al. User charges for health care: a review of recent experience. Discuss the 2 main branches of neoclassical economics that deal with environmental and resource issues. Inclusion criteria applied in review of studies of the effects of user fees on health service utilization in low- and middle-income countries, Table 2. A portion of the total cost known as fixed cost—e.g., the costs of a building lease or of heavy machinery—does not vary with the quantity produced and, in the short run, does not alter with changes in the amount produced. When resources are scarce, greater current use diminishes future opportunities. an unplanned cost or benefit of economic activity and production, positive externality is a benefit, negative externality is a cost. Transaction Cost Economics focuses on the organization of transactions that occur whenever a good or service is transferred from a provider to a user across a technologically separable interface. How can systematic reviews incorporate qualitative research? In a C-RCT of good quality, Kremer and Miguel32 showed that uptake of worm-prevention treatment in Kenyan schools fell from 75% to 19% after fees were introduced. One, This review is the first attempt to systematically assess the quality of existing evidence on the subject of charging for health services in low-income countries. The user cost of capital is also referred to as the “rental price” of a capital good, or the “capital service price". Gilson L. The lessons of user fee experience in Africa. Corrections? This review is the first attempt to systematically assess the quality of existing evidence on the subject of charging for health services in low-income countries. McDowall D, McCleary R, Meidinger E, Hay R. Ojeda G, Murad R, Leon F, Williams T. Testing pricing payment systems to improve access and cost-recovery from Norplant. The concept is useful in determining the optimum levels of investment and exploitation in a renewable natural resource like forestry. Russell S. Illuminating cases: understanding the economic burden of illness through case study household research. The result is that our findings are heterogeneous and hard to summarize quantitatively. A critical perspective. where Yt is the outcome variable at time t. Intervention is coded 0 for pre-intervention time points and 1 for post-intervention time points; its coefficient β2 reflects the immediate impact of the intervention on the dependent variable. Thus, the MARGINAL USER COST = Present Value of forgone opportunities at the margin. Weighing economic costs against human lives will inevitably seem crass. Collins D, Quick JD, Musau SN, Kraushaar K, Hussein IM. In: Diop F, Yazbeck A, Bitrán R. The impact of alternative cost recovery schemes on access and equity in Niger. The revenue generating potential of user fees in Kenyan government health facilities. The development of the concept of user cost has been traced and its application in the economics of natural resources has been shown. We searched 25 databases covering the social science, economics and health literature. A firm desiring to maximize its profits will, in theory, determine its level of output by continuing production until the cost of the last additional unit produced (marginal cost) just equals the addition to revenue (marginal revenue) obtained from it. In a basic economic sense, cost is the measure of the alternative opportunities foregone in the choice of one good or activity over others. Marginal cost is the additional cost incurred in the production of one more unit of a good or service. Good impact evaluations seem difficult to apply to health systems.45 This is partly for economic reasons (they are costly and labour intensive) and partly for ethical and political ones (it is difficult to give services to some communities and not to others in order to create control groups). Abolition of cost-sharing is pro-poor: evidence from Uganda. Oliver E. Williamson defines transaction costs as the costs of running an economic system of companies, and unlike production costs, decision-makers determine strategies of companies by measuring transaction costs and production costs. The impact of user fee exemption on service utilization and treatment seeking behaviour: the case of malaria in Sudan. In environmental economics, marginal cost … This answers the question, “how much will the company spend in order to get one user to avail of its internet service?” Using the marginal benefits / marginal costs per … However, high inflation at the time in Colombia may have caused people to overestimate the real fall in price. Despite a sizeable literature published on this issue and some vigorous debate spanning several decades, there is still a scarcity of good quality evidence. However, this study was again subject to limitations due to confounding factors (high inflation may have confused real price variations) and a failure to follow the initial experimental design. User fees refer to a financing mechanism that has two main characteristics: payment is made at the point of service use and there is no risk sharing. Thus the cost of generating electricity by burning high-sulfur bituminous coal can be measured not only by the cost of the coal and its transport to the power plant (among other economic considerations) but also by its cost in terms of air pollution. Background The detrimental impact of smoking on health has been widely documented since the 1960s. Coronavirus disease outbreak (COVID-2019), Coronavirus disease outbreak (COVID-19) », Table 1. Kremer M, Miguel E. The illusion of sustainability. Microeconomics Topic 1: “Explain the concept of opportunity cost and explain why accounting profits and economic profits are not the same.” Reference: Gregory Mankiw’s Principles of Microeconomics, 2nd edition, Chapter 1 (p. … When only one criterion was unclear or unmet, it was scored as being of “moderate” quality, and when all elements were satisfied, the study was considered as being of “high” quality. Two studies suggested that the combination of user fees and improvements in quality can increase utilization. Only studies from low- and middle-income countries, as defined by the World Bank, were included. Observational or qualitative case studies,38 studies of policy implementation39 and costing studies play an important role in helping understand how policies get implemented. Definition: The user cost of capital is the unit cost for the use of a capital asset for one period--that is, the price for employing or obtaining one unit of capital services. When external costs arise because environmental costs are not paid, market failures and economic inefficiencies at the local, state, national, and even international level may result. Cost, in common usage, the monetary value of goods and services that producers and consumers purchase. Total cost is graphed with output quantity on the horizontal axis and dollars of total cost on the vertical axis. Eight papers presented data on the effects of introducing user fees (Table 3), five on the effects of removing fees (Table 4) and five on the effects of decreasing or increasing fees (Table 5 and Table 6). Ridde V. Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. We also searched the reference lists of all relevant articles, the web sites of related research centres or institutions (lists of sources searched are available from the authors upon request) and existing reviews. Burnham GM, Pariyo G, Galiwango E, Wabwire-Mangen F. Discontinuation of cost sharing in Uganda. A similar problem in two experimental studies was that high inflation may have confused the effects of price variations. Most studies providing longitudinal data (and reanalysed as ITS) were unable to isolate changes in charges for health services from other concurrent changes occurring in, or outside of, the health system. A review of the evidence from selected countries on user fees and determinants of health service utilisation. User Fee: A sum of money paid by the individual who chooses to access a service or facility. What is a marginal user cost? Finally, very little large-scale research funding has been available in the area of health financing or health systems research. user cost is the present value of these forgone opportunities at the margin marginal user cost increases at the rate of interest (discount rate) over time in nominal terms present value of marginal user costs are equal over time There may be value in narrowing down the scope of such reviews in the future, although this must be balanced against the paucity of papers on any given subject. They then reviewed one another’s conclusions. CRTs – cluster randomized trials or “courting real troubles”: challenges of running a CRT in rural Gujarat, India. O’Donnell O, van Doorslaer E, Rannan-Eliya R, Somanathan A, Adhikari SR, Harbianto D, et al. User fees refer to a financing mechanism that has two main characteristics: payment is made at the point of service use and there is no risk sharing. ■. Access to basic health services of acceptable quality is still denied to many of the world’s poorest people.1 Against a backdrop of severely underfunded health systems,1,2 governments are faced with a dilemma. What is the definition of total cost? Moses S, Manji F, Bradley JE, Nagelkerke NJ, Malisa MA, Plummer FA. Definition: Total cost is an economic measure that sums all expenses paid to produce a product, purchase an investment, or acquire a piece of equipment including not only the initial cash outlay but also the opportunity cost of their choices. However, the quality of the data from which these conclusions were drawn was judged to be low due to the presence of confounding factors (concurrent policy changes), the questionable quality of routine data or small sample sizes. Why is this the case? It must be stressed that the quality of the available evidence was low. Marginal User Cost Inter-Temporal Fairness (Sust. The impact of price changes on demand for family planning and reproductive health services in Ecuador. We included three studies reporting the effects of increasing user fees. They concur with those of some of the non-systematic reviews on user fees that have been completed.15–17 However, we feel that there are several important questions in this area that remain unanswered, and it is important to note that all but one of the studies had significant weaknesses. Community financing of health care in Africa: an evaluation of the Bamako initiative. A particular weakness was that only two studies looked at differential impact across population groups.4,29 Most studies on routine data could not assess the equity impact of the reforms described. When a study presented unsatisfactory or unclear elements for two or more criteria, it was scored as being of “low” quality. An experiment in Ecuador30 found that demand for reproductive health services (obstetric-gynaecological, antenatal care) in private clinics was inelastic to changes in prices. In one study there may also have been problems controlling whether free care was really free in control areas.36. Quality criteria were adapted from those suggested by the EPOC group of the Cochrane Collaboration (Table 2). Marginal User Cost. There are a few features to note about the total cost curve: The total cost curve is upward sloping (i.e. Luckily, t… Eight studies examined the effect of introducing user fees: two CBA studies, We included three studies reporting the effects of increasing user fees. Updates? Cost Theory – Types of Costs The concept is useful in determining the optimum levels of investment and exploitation in a renewable natural resource like forestry. A critical review of economic literature with particular reference to experience from developing countries. Cost, in common usage, the monetary value of goods and services that producers and consumers purchase. Issifou S, Kremsner PG. Variable costs, like the costs of labour or raw materials, change with the level of output. Marginal user cost in depletable resources 2.964: Economics of Marine Transportation Industries Prof. Hauke Kite-Powell Lecture Notes: Environmental Economics Page 2 of 4 Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review – a new method of systematic review designed for complex policy interventions. This simply reflects the fact that it costs more in total to produce more output. This company’s unit is the user, and it has two fundamental unit economics: Cost to acquire or recruit one user (or the Cost per Acquisition). Data from Lesotho33 showed that increasing user fees led to a drop in utilization in the public sector, while uptake of services in private not-for-profit facilities did not change. James CD, Hanson K, McPake B, Balabanova D, Gwatkin D, Hopwood I, et al., et al. In Gabon,34 data from two increases in fees in a private hospital showed that demand became increasingly sensitive to price, which suggests a threshold effect. Papers were assessed only if the effect of the intervention was measured in terms of either changes in utilization, household expenditure, health outcome or equity. However, several data series showed that after fees were removed, the growth in preventive service utilization significantly increased (or, in South Africa, declined at a more modest rate), which could be interpreted as a long-term trickle-down effect of fee removal (Table 7). Marginal cost is the additional cost incurred in the production of one more unit of a good or service. For example, a new car manufacturing plant brings increased revenue for area restaurants and increased traffic leading to the need to spend for new highways. Omissions? Cost, in common usage, the monetary value of goods and services that producers and consumers purchase. Main characteristics of studies on increasing user fees and its effects on health service utilization in low- and middle-income countries, according to literature review, Table 8. Key questions include the effects of fee changes on the quality of care, drug use and health worker motivation as well as utilization. Both authors independently sifted the titles and abstracts of publications for retrieval. Postslope is coded 0 up to the last point before the intervention phase and coded sequentially from 1 thereafter. For economists, cost has another dimension, one that includes not just actual expenditures but forgone opportunities. The user cost of capital also is sometimes referred to as the “ implicit rental price ” or the “ price of capital services. The welfare implications of health care financing proposals in Peru. Main characteristics of studies on the introduction of user fees and its effects on health service utilization in low- and middle-income countries, according to literature review, Table 4. The meaning of this term varies slightly depending on the content. As a result, a narrative approach to reporting the results has been adopted. Marginal cost – definition. However, these studies have mostly been in high income countries, with limited documentation from developing countries. Economics 230a Fall 2011 Derivation of the User Cost of Capital Consider a firm wishing to maximize its value at date t, (1) t s r s t V t e X ds ( ), where r is the discount rate that applies to the corporation’s real activities and X s is the firm’s cash flow at date s from these activities, (2) X p F K q I k D s u q u I u du s But in economics, cost is used in a broader sense. ” A capital asset in theory can be any asset that is long-lived, … For each included study, both authors extracted data and assessed quality. But firms come in all sizes, as shown in Table 2.1. Impact of user charges on vulnerable groups: the case of Kibwezi in rural Kenya. The aim of this paper is to measure the economic cost … Five studies used longitudinal data to report the effects of abolishing user fees on utilization. Sepehri A, Chernomas R. Are user charges efficiency- and equity-enhancing? Bulletin of the World Health Organization. Reflections on the current debate in low- and middle-income countries. Gertler P, Locay L, Sanderson W. Are user fees regressive? All retrieved articles were then independently reviewed by the two authors, and agreement was reached over whether they fulfilled the criteria for inclusion in the review. Whenever the authors could not be found or did not respond, we attempted to reconstruct data series by scanning graphs.1. increasing in quantity). We only found studies reporting effects on health service utilization. Private enterprise, the ownership of businesses by private individuals, is a hallmark of the U.S. economy. These were all reanalysed. We also computed the statistical significance of the observed effects if it was not reported in the original paper. They are typically paid for each visit to a health service provider, although in some cases follow-up visits for the same episode of illness can be covered by the initial payment. The two CBA studies4,29 examined the effects of introducing user fees alongside quality improvements, and both found that this increased utilization for the poorest groups. By signing up for this email, you are agreeing to news, offers, and information from Encyclopaedia Britannica. Cost Theory – Types of Costs These findings broadly support the view that user fees present a barrier to access to curative health services for those groups that would be eligible to pay for them. It is derived from the variable cost of production, given that fixed costs do not change as output changes, hence no additional fixed cost is incurred in producing another unit of a good or service once production has already started. In a basic economic sense, cost is the measure of the alternative opportunities foregone in the choice of one good or activity over others. They concur with those of some of the non-systematic reviews on user fees that have been completed. The user cost of capital is also referred to as the “rental price” of a capital good, or the “capital service price". These were all reanalysed.22,24–26,35 Results from the reanalysis confirm an abrupt increase in the utilization of curative services following fee removal (Table 7). 0 up to the inclusion of 243 documents for further investigation ( Fig was detected by the EPOC of... Offers, and information from Encyclopaedia Britannica in social science delivery features to note about the total cost the. A regression analysis, the ownership of businesses by private individuals, is a hallmark of the owner-manager to. Of illness through case study household research good or service relationship between the value of production is fixed so... The individual who chooses to access the rate of interest / discount rate increases, so firms both. 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