Editorials

User fees

If user fees for health care are the solution, what exactly is the problem? Proponents of user fees recommend them in two situations. The first is when health spending in total is low or falling—fees are recommended as a way to mobilise more money for health care than existing sources provide. The second, paradoxically, is when health expenditure is high or rising quickly, when fees are recommended as a way of improving efficiency by moderating demand and containing costs.^{1 2} Opponents of user fees attack them as a political strategy for shifting healthcare costs from the better off to the poor and the sick, pointing to the trade off between this method of raising revenue and maintaining access to care based on need rather than ability to pay.³

Dramatic differences exist between countries. Levels of and trends in national income and the condition of health systems vary widely among countries, and . . . [Full text of this article]

Limited success at managing demand
Profound effects on access

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• Jayasinghe, S. A (2006). Where next for China? User fees increase China's health challenges.. BMJ 333: 499-500 [Full text]  
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• Stott, R. (1999). The World Bank. BMJ 318: 822-823 [Full text]  
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