[afro-nets] User fees for health care: a new key issues guide

User fees for health care: a new key issues guide
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Please find details below of a new Eldis Health Systems key is-
sues guide which I hope will be of interest to AFRO-NETS sub-
scribers.

User fees - killer bills or vital funds?

User fees for health care are widespread around the developing
world, but opposition to them is growing. Many studies have
found them to be a barrier to the use of health services, par-
ticularly among poor people. Amid concerns that they will pre-
vent the Millennium Development Goals from being met, research-
ers, advisers, and policy makers have questioned whether user
fees should be applied at all.

Yet there are reasons to be cautious about abolishing user fees.
Other financial barriers - such as the cost of purchasing drugs,
unofficial fees, and transport costs - are often more important
than user fees, and abolishing them would remove a relatively
small, but often vital source of funding. Unless this funding is
replaced from other sources, there could be adverse consequences
for quality of service. User fees may also be a necessary part
of other mechanisms for financing health care, such as insurance
schemes. They therefore have to be seen within the broader con-
text of health systems financing.

Produced in collaboration with the DFID Health Resource Centre,
this new Eldis Health Systems key issues guide examines evidence
on the impact of user fees and presents some of the ongoing de-
bates in health financing policy. It considers arguments for and
against abolishing fees, and provides recommendations for donors
and governments on how fees should work if they are kept.

Access the guide at:
http://www.eldis.org/healthsystems/userfees/

--
Stuart Cameron
Research Assistant, Health Resource Guides
Institute of Development Studies, UK
Tel. +44-1273-873-335
mailto:S.Cameron@ids.ac.uk

--
Eldis - the gateway to development information - and the DFID
Health Resource Centre (HRC) - bring you information, research
and resources on...
health - http://www.eldis.org/health
health systems - http://www.eldis.org/healthsystems
HIV and AIDS - http://www.eldis.org/hivaids

User fees for health care: a new key issues guide (2)
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To my mind, nothing should be given free, lest its value is not
known and invariably, the benefit is misused/abused, by the pow-
ers that be, middlemen and the beneficiary themselves.

We have seen the above in thousands of cases, including Tsunami
relief, where the actual sufferer does not get the benefit!!

Charge the right fees, not inflated fees. Make transparency the
norm, than an exception and make everyone accountable for their
action.

Kris Dev
mailto:krisdev@gmail.com

User fees for health care: a new key issues guide (3)
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Sorry, Kris,

You wrote:
> Charge the right fees, not inflated fees.

As a blanket statement, you could not be more wrong on this. The
evidence is against you!

Claudio Schuftan
mailto:claudio@hcmc.netnam.vn

User fees for health care... (4)
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hehehe... this user fees issue seems interesting. We have just
had a look at user fees in my health economics class and all the
info seems to point at fees being a discouragement towards
healthcare seeking, and this includes all fees... official and
under the table(!) in developing countries and even in the de-
veloped ones where individuals can't afford the insurance. The
question is where will the money come from to run the systems in
LDC's since there is not a sufficient tax base to support free
healthcare like for the case of Britain?

Isaac Kigozi
mailto:kigoziisaac76@yahoo.co.uk

User fees for health care... (5)
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Dear All,

The WHO has two recent documents on user fees for immunizations.
Essentially, the WHO Findings on the implementation of user fees
are:
1) User fees discourage people from seeking vaccination.
2) Public funding is the most equitable way to finance essential
    immunization.
3) Essential immunization services should be free of charge.

Here are the links to these two documents:
A) Practice and policies on user fees for immunization in devel-
oping countries (Adobe PDF file 32 pp. 170 kB):
http://www.who.int/vaccines-documents/DocsPDF01/www564.pdf

B) Fact Sheet on User fees for immunization in developing coun-
tries (Adobe PDF file 2 pp. 291 kB):
http://www.who.int/vaccines-documents/DocsPDF01/www563.pdf

Best,

Tom O'Connell
Consultant, health policy and planning
mailto:tsoconnell2@yahoo.com