User Fee Impact on Equitable Access to Care: A Review

Abstract

Access to care and equity are the two most pertinent issues for policy-makers of the current era. In developing countries, health care is continuously facing budget constraints as central governments’ expenditures do not reach peripheral level of health care. Lack of resources and emphasis on systems’ sustainability has supported the concept of user charges. However, the World Health Organisation (WHO) has recently urged developing countries to not rely on user fee as a source of fund, based on the economic theory that high prices induce negative demand, especially for vulnerable populations, which invariably raises the issue of user fee widening inequity. This article reviews the evidences from low and middle-income countries to analyze various political agendas supporting user fee policies and their impact on health facilities in terms of utilization and availability of resources in view of barriers to access. The evidences highlighted that access to care is largely affected by unavailability of resources in most African countries whereas India grapples continuously with governance issues for improving efficiency of health care facilities. The success of the concept of user fee lies in careful examination of health care system-capacity issues, providing a support mechanism for the vulnerable and restructuring user fee policy around efficiency rather than cost-recovery mechanism.