User fees have been a matter of debate in developing countries1,2,3,4,5. Even in developed countries taking the examples of USA and UK, the former country has privatized health care and the latter has the NHS which is government owned free set-up.

In low income and middle income countries user fees further impoverish the people who are already poor1,2,3,4,5. It is observed in these countries that user fees do not improve the quality.

A socially accepted and sustainable model of health insurance should be tried instead.

References:
1: Jacobs B, Price N. The impact of the introduction of user fees at a districthospital in Cambodia. Health Policy Plan. 2004 Sep;19(5):310-21.

2: Nabyonga-Orem J, Karamagi H, Atuyambe L, Bagenda F, Okuonzi SA, Walker O.Maintaining quality of health services after abolition of user fees: a Uganda case study. BMC Health Serv Res. 2008 May 9;8:102.

3: James CD, Hanson K, McPake B, Balabanova D, Gwatkin D, Hopwood I, Kirunga C,Knippenberg R, Meessen B, Morris SS, Preker A, Souteyrand Y, Tibouti A, Villeneuve P, Xu K. To retain or remove user fees?: reflections on the currentdebate in low- and middle-income countries. Appl Health Econ Health Policy.2006;5(3):137-53. Review.

4: Stanton B, Clemens J. User fees for health care in developing countries: a case study of Bangladesh. Soc Sci Med. 1989;29(10):1199-205.

5: Mbugua JK, Bloom GH, Segall MM. Impact of user charges on vulnerable groups:the case of Kibwezi in rural Kenya. Soc Sci Med. 1995 Sep;41(6):829-35.

Competing interests: None declared