This paper attempts to evaluate the responsiveness of consumers to changes in the costs of health care. The paper analyzes the demand for health care in rural Cote D'Ivoire, where user fees are zero, but private access costs may be substantial. Using a mixed discrete choice/continuous demand analytical framework, it shows that the absence of fees per se, does not guarantee equal access to all consumers. Private costs, represented by travel time, result in rationing similar to the conventional money price mechanism. The results strongly suggest that if revenues obtained from user fees are used to improve the regional distribution of services, the resulting system may actually improve equity over the long run.