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Mobilizing Resources for Health: The Case for User Fees Revisited

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  • Dyna Arhin-Tenkorang

Abstract

During the 1980s and 1990s, health sector reforms to improve the efficiency of health systems and the quality of care provided were implemented in low-income countries, mainly in Africa. The reforms included the introduction or consolidation of cost recovery mechanisms, otherwise known as user fees. The paper provides evidence from the literature that in most instances user fees had the unintended effect of decreasing access to health care by the poor. It argues that user fees, in addition to having been largely unsuccessful in raising significant resources, greatly contributed to increasing the exposure of poor households to the financial risks associated with illness. A major conclusion is that alternate financing mechanisms are required to provide financial risk protection to low-income households, particularly to those in the informal sector.

Suggested Citation

  • Dyna Arhin-Tenkorang, 2001. "Mobilizing Resources for Health: The Case for User Fees Revisited," CID Working Papers 81, Center for International Development at Harvard University.
    • Handle: RePEc:cid:wpfacu:81
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    References listed on IDEAS

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    1. McPake, Barbara, 1993. "User charges for health services in developing countries: A review of the economic literature," Social Science & Medicine, Elsevier, vol. 36(11), pages 1397-1405, June.
    2. Litvack, Jennie I. & Bodart, Claude, 1993. "User fees plus quality equals improved access to health care: Results of a field experiment in Cameroon," Social Science & Medicine, Elsevier, vol. 37(3), pages 369-383, August.
    3. Martine AUDIBERT & Jacky MATHONNAT, 1998. "Cost Recovery in Mauritania: Initial Lessons from Reform," Working Papers 199811, CERDI.
    4. Yoder, Richard A., 1989. "Are people willing and able to pay for health services?," Social Science & Medicine, Elsevier, vol. 29(1), pages 35-42, January.
    5. Stanton, Bonita & Clemens, John, 1989. "User fees for health care in developing countries: A case study of Bangladesh," Social Science & Medicine, Elsevier, vol. 29(10), pages 1199-1205, January.
    6. Lucy Gilson & Steven Russell & Kent Buse, 1995. "The political economy of user fees with targeting: Developing equitable health financing policy," Journal of International Development, John Wiley & Sons, Ltd., vol. 7(3), pages 369-401, May.
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    Cited by:

    1. Agar Brugiavini & Noemi Pace, 2016. "Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care," Health Economics Review, Springer, vol. 6(1), pages 1-10, December.
    2. Taiwo Obembe & Sharon Fonn, 2020. "Affording unavoidable emergency surgical care – The lived experiences and payment coping strategies of households in Ibadan metropolis, Southwestern Nigeria," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-18, May.
    3. Krůtilová, Veronika & Yaya, Sanni, 2012. "Unexpected impact of changes in out-of-pocket payments for health care on Czech household budgets," Health Policy, Elsevier, vol. 107(2), pages 276-288.
    4. Xu, Ke & Evans, David B. & Kadama, Patrick & Nabyonga, Juliet & Ogwal, Peter Ogwang & Nabukhonzo, Pamela & Aguilar, Ana Mylena, 2006. "Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda," Social Science & Medicine, Elsevier, vol. 62(4), pages 866-876, February.
    5. Veronika Krůtilová, 2016. "Access to Health Care and the Out-of-Pocket Burden of the European Elderly," Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis, Mendel University Press, vol. 64(6), pages 1961-1970.
    6. Alagidede, Paul & Baah-Boateng, William & Nketiah-Amponsah, Edward, 2013. "The Ghanian economy: and Overview," MPRA Paper 109687, University Library of Munich, Germany.
    7. Richardson, Jeff & McKie, John, 2007. "Economic evaluation of services for a National Health Scheme: The case for a fairness-based framework," Journal of Health Economics, Elsevier, vol. 26(4), pages 785-799, July.
    8. Dai Baozhen & Minkah Andrews Yaw & Osei-Assibey Mandella Bonsu & Agyemang Fredua Sylvester Prempeh, 2019. "Assessing Factors Affecting the Patronage of Health Insurance Schemes: An Evidence of Ghana," Journal of Public Administration and Governance, Macrothink Institute, vol. 9(1), pages 73-91, March.

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    More about this item

    Keywords

    user fees; cost recovery; access to health; financial risk protection; Afric;
    All these keywords.

    JEL classification:

    • H4 - Public Economics - - Publicly Provided Goods
    • I1 - Health, Education, and Welfare - - Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O1 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development

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