William Newbrander, David Collins and Lucy Gilson (eds), Ensuring equal access to health services: user fee systems and the poor, King Printing Company: Boston, MA, USA, 2000, 179 pp., ISBN 0-913723-79-7, $20.00

✍ Scribed by Sharif Ullah Khan

• Publisher: John Wiley and Sons
• Year: 2002
• Tongue: English
• Weight: 44 KB
• Volume: 17
• Category: Article
• ISSN: 0749-6753
• DOI: 10.1002/hpm.677

✦ Synopsis

according to service level, quality, and users' ability to pay. The authors argue for provision of free emergency services and, where fees are charged, high quality public information about the fee structure. In regard to implementation aspect, a number of matters are considered: introducing an acceptable level of fee types first; low fees; reducing exemptions over time; and gradual introduction of fees beginning from highest level of facility. For the management aspect, the authors suggest a focus on setting revenue targets; continuous monitoring; and, ensuring accountability for exemptions and waivers.

Overall, this book provides simple and practicable guidelines about designing, implementing and managing an equitable user fee system. It provides a rich source of information on different exemption mechanisms and means testing procedures. These might be useful for avoiding equity and access issues associated with the implementation of user fee systems, provided they are considered both at policy and facility level. The major lesson emerging out of this booklet is that for the user fee system to be effective and equitable, it should be supplemented with workable waiver and exemption mechanisms, and the revenues generated from the fees should be reinvested in quality improvements. Although complex, the establishment of a viable user fee system is possible and the booklet helps work through the choices to be faced, and the principles and evidence available to guide decisions.