User fees
User fees have been widely implemented throughout the developing world since the early 1980s under the Bamako Initiative, which advocated for cost sharing and community participation to (in theory) increase the sustainability and quality of health services. The continuing application of user fees has been a highly controversial issue.
There is now a considerable literature on the impact of user fees. This includes documents examining alternatives to user fees or ways of adapting the user fee mechanism to reduce the negative consequences (e.g. user fee exemptions, community health insurance). The appropriateness of user fees for services used by the poor has become an important point of debate, particularly in the light of commitments made to achieve international development targets.
- Paying out-of-pocket for health care in Asia: catastrophic and poverty impact
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This Equitap paper analyses the extent of out-of-pocket (OOP) payments for healthcare in 14 countries in Asia, and the impact of these payments on household’s income and resources and vulnerability to poverty. It finds that the heavy reliance on OOP financing for healthcare has important consequences for living standards.
Recommended readings
- World Development Report 2004: making services work for poor people
- ( World Development Report, World Bank , 2003)
- Recommended reading
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This issue of the WDR focuses on policies for improving the access of poor people to affordable, better quality services in health, education, water, sanitation, and electricity.
The report focuses ...
- Mobilizing resources for health: the case for user fees revisited
- ( D. Arhin-Tenkorang / World Health Organization , 2000)
- More than a decade has passed since many developing countries introduced user fees for health services, but so far the benefits predicted by the World Bank and others have not been achieved. This wor...
- Waivers and exemptions for health services in developing countries
- ( R. Bitrán; U. Giedion / World Bank , 2003)
- The problem with user fees is that the poorest people might not be able to pay them, and so not get the health care they need. This discussion paper from the World Bank Institute’s Social Safety Net P...
Latest Additions
- Comparison of user fees and community insurance schemes for health care financing in Tanzania
- ( D. P. Mushi / Research on Poverty Alleviation, Tanzania , 2007)
- This paper, published by Research for Poverty Alleviation (REPOA), compares the welfare effects of a community based insurance scheme - the Community Health Fund (CHF) - and user fees for public healt...
- Policies for making access to health care equitable in Uganda and Cambodia
- ( B. Meessen;W. Van Damme;C. K. Tashobya;A. Tibouti / The Lancet , 2006)
- This Lancet article examines two countries efforts towards making access to health care more equitable. It compares the abolition of user fees in Uganda and the establishment of health equity funds in...
