Scope of User Charges

Limiting the scope of user charges levied in government/public healthcare centres and relating it to the more fundamental question of equity concern (i.e. the extent to which such charges serve to dissuade the poor from availing the services in public hospitals), therefore, provides a narrow view of the concept. The concept merits to be viewed from a much larger perspective i.e., one of resources required for expanding the healthcare services. In other words, in the absence of a proper perspective of distinctions (e.g. distinguishing the goals from the instruments, or distinguishing the user fees for public services from the overall and much larger

Table: Arguments For and Against User Fees

out-of-pocket spending on health needs, etc.) the larger issue of improving the access to healthcare services in an equitable, efficient, and on a sustainable basis remains inadequately focused. Further, the objective of finding the resources for achieving the millennium development goals of health, needs to be especially distinguished from the different instruments available for raising the resources (e.g. domestic resource mobilisation, external/donor assistance, improving the technical/ allocative efficiency of spending, etc.) of which the levying of ‘user charges’ is one of the options.