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Health Policy and Planning; 6(4): 309-319
© 1991

review-article

User charges for health care: a review of recent experience

ANDREW L CREESE

Division of Strengthening Health Services, World Health Organization Switzerland

Andrew Creese, Division of Strengthening Health Services, World Health Organization, CH-1211 Geneva 27, Switzerland

This paper reviews recent experiences with increases in user charges and their effect on the utilization of health care. Evidence from several countries of differences in utilization between rich and poor is presented, and recent accounts of sharp, and often sustained, drops in utilization following fee increases, are presented and discussed.

Fee income, appropriately used, represents a small but significant additional resource for health care. Recent national experiences appear to have concentrated on achieving cost recovery objectives, rather than on improving service quality and health outcomes. Appraisal of financing changes must be linked to probable health outcomes. Successful large-scale experience in linking these two is in short supply.


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