BMJ  2006;333:499-500 (2 September), doi:10.1136/bmj.333.7566.499-b

Letter

Where next for China?

User fees increase China's health challenges

The first 150 words of the full text of this article appear below.

EDITOR—The editorial by Liu does not give adequate consideration to the policy option of health services at zero cost to users.¹ The evidence from China confirms previous evidence that introducing user fees for health care reduces use of health care and thereby adds to human misery.² For elderly people in China, medical cost (user fees) is the main reason for 40% of those not visiting a doctor and 75% of those not gaining admission to hospitals. Another argument against user fees is that it worsens health inequities.³ The human costs of prolonged illness at old age and the increase in long term health costs from delayed treatment are further disadvantages.

Even developed economies of Europe have steadfastly maintained some facet of a policy of zero user fees. In many, the only out of pocket expense is a partial payment for drugs.³ Developing countries, such as Sri Lanka and . . . [Full text of this article]

Barking, Havering and Redbridge Hospitals NHS Trust, Romford RM7 0BE adosaroj@hotmail.co.uk

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