Removing user fees: learning from international experience to support the process.
Health Policy Plan
; 26 Suppl 2: ii104-117, 2011 Nov.
Article
in En
| MEDLINE
| ID: mdl-22027915
ABSTRACT
Removing user fees could improve service coverage and access, in particular among the poorest socio-economic groups, but quick action without prior preparation could lead to unintended effects, including quality deterioration and excessive demands on health workers. This paper illustrates the process needed to make a realistic forecast of the possible resource implications of a well-implemented user fee removal programme and proposes six steps for a successful policy change (1) analysis of a country's initial position (including user fee level, effectiveness of exemption systems and impact of fee revenues at facility level); (2) estimation of the impact of user fee removal on service utilization; (3) estimation of the additional requirements for human resources, drugs and other inputs, and corresponding financial requirements; (4) mobilization of additional resources (both domestic and external) and development of locally-tailored strategies to compensate for the revenue gap and costs associated with increased utilization; (5) building political commitment for the policy reform; (6) communicating the policy change to all stakeholders. The authors conclude that countries that intend to remove user fees can maximize benefits and avoid potential pitfalls through the utilization of the approach and tools described.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Internationality
/
Fees and Charges
/
Health Services Accessibility
Type of study:
Health_economic_evaluation
Aspects:
Determinantes_sociais_saude
Limits:
Humans
Language:
En
Journal:
Health Policy Plan
Journal subject:
PESQUISA EM SERVICOS DE SAUDE
/
SAUDE PUBLICA
Year:
2011
Document type:
Article
Affiliation country:
United kingdom