Universal health coverage and user charges

Title Universal health coverage and user charges
Year 2013
Author P. C. Smith
URL http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9004658&fileId=S1744133113000285
Journal Health Economics, Policy and Law
Document Type Journal Article
Document Availability Abstract
Classification Other complementary UHC initiatives
Abstract There has been an explosion of interest in the concept of ‘universal health coverage’, fuelled by publication of the World Health Report 2010. This paper argues that the system of user charges for health services is a fundamental determinant of levels of coverage. A charge can lead to a loss of utility in two ways. Citizens who are deterred from using services by the charge will suffer an adverse health impact. And citizens who use the service will suffer a loss of wealth. The role of social health insurance is threefold: to reduce households’ financial risk associated with sickness; to promote enhanced access to needed health services; and to contribute to societal equity objectives, through an implicit financial transfer from rich to poor and healthy to sick. In principle, an optimal user charge policy can ensure that the social health insurance funds are used to best effect in pursuit of these objectives. This paper calls for a fundamental rethink of attitudes and policy towards user charges.


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