Many low- and middle-income countries continue to search for better ways of financing their health systems. Common to many of these systems are problems of inadequate resource mobilisation, as well as inefficient and inequitable use of existing resources. The poor and other vulnerable groups who need healthcare the most are also the most affected by these shortcomings. In particular, these groups have a high reliance on user fees and other out-of-pocket expenditures on health which are both impoverishing and provide a financial barrier to care. It is within this context, and in light of recent policy initiatives on user fee removal, that a debate on the role of user fees in health financing systems has recently returned. This paper provides some reflections on the recent user fees debate, drawing from the evidence presented and subsequent discussions at a recent UNICEF consultation on user fees in the health sector, and relates the debate to the wider issue of access to adequate healthcare.
James, C.; Hanson, K.; McPake, B.; Balabanova, D.; Gwatkin, D.; Hopwood, I.; Kirunga, C.; Knippenberg, R.; Meesen, B.; Morris, S.; Preker, A.; Soucat, A.; Souteyrand, Y.; Tibouti, A.; Villeneuve, P.; Xu, K. To retain or remove user fees: Reflections on the current debate. Applied Health Economics and Health Policy (2006) 5 (3) 137-153.