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Corruption in public health 105about the same as those in other income brackets when they didpay, and income had no effect on the probability of having to pay(Hotchkiss et al., 2005). Estimates of the price elasticity of smallincreases in the price of health services using a national representativesurvey found almost no effect, indicating that patients are notparticularly price sensitive in Albania (World Bank, 2003a).Exemption for fees offers the potential for husbanding scarceresources for those least able to afford health care. Many systemshave instituted such procedures to retain the benefits of copaymentswithout unduly burdening the poor (World Bank, 2004).Evidence on effectiveness, however, suggests problems with theapproach. In Bangladesh data from interviews and observation in asample of four hospitals showed that 75 per cent of the time thelowest income group paid the least amount both officially and unofficially.In the outlier institution the poor paid more than the wealthiestgroup but the same as or less than the middle income patients.Payments are also standardized and routinized with specific timeperiods for charging during inpatient stays rather than at discharge(Killingsworth et al., 1999).In Rajasthan, India patients regularly pay for “free” outpatientcare, though the poorest patients pay 40 per cent less than thehighest income patients, though it should be noted that in thispart of India everyone is poor it is simply a matter of degree. Onaverage 7.3 per cent of total household spending goes to payingfor health care (Banerjee, Deaton and Duflo, 2004). In Ugandaexemptions were extended to the politically powerful and thoseoverseeing the local health care program (McPake et al., 1999), aperverse version of exemption meant to ensure equal access butin this case subsidizing the better off. Central Asia’s experiencehas not been encouraging either with minimal exemptions forlower income patients (Falkingham, 2004). Evidence from Kazakhstanshowed that for major illnesses the lowest income householdsspent more than twice their monthly income for health carewhile the wealthiest households spent the equivalent of half theirmonthly income reflecting the lack of exemptions for the poor