Punishing the Poor? A Look at Evidence and Action Regarding User Fees in Health Care

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Centre for Enquiry into Health and Allied Themes, Jun 1, 2011 - Medical - 14 pages

“There’s now just overwhelming evidence that those user fees actually worsened health outcomes. There’s no question about it. So did the bank get it wrong before? Yeah. I think the bank was ideological”  - Dr Jim Yong Kim, World Bank Head. (2014)

User fees for health care were put forward as a way to recover costs and discourage the excessive use of health services and the over- consumption of care. This did not happen. Instead, user fees punished the poor. -Dr. Margaret Chan, Director-General, WHO. (2009)

The history of user fees imposed on the poor is a history of the poor being excluded from basic services. – Jeffrey Sachs, Director, Earth Institute, End of Poverty (2005)
Pricing helps reduce excessive or unwarranted demand for a service and brings supply capacity more in line with willingness and ability to pay. Put differently, when a service costs money, people will think twice about demanding it.
- World Bank, Financing health care in sub-Saharan Africa through user fees and insurance. (1995)


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