Safety Nets Primer Resources - Fee Waivers for Health Services

 Waivers and Exemptions for Health Services in Developing Countries (550KB PDF). Also available in Español (671KB PDF) ◘ Français (587KB PDF)
Social Protection Discussion Paper No. 0308; Publication Date: 03/03
by Ricardo Bitrán and Ursula Giedion

In response to shortages in public budgets for government health services, many developing countries around the world have adopted formal or informal systems of user fees for health care.  In most countries user fee proceeds seldom represent more than 15 percent of total costs in hospitals and health centers, but they tend to account for a significant share of the resources required to pay for non-personnel costs.  The problem with user fees is that the lack of provisions to confer partial or full waivers to the poor often results in inequity in access to medical care.  The dilemma, then, is how to make a much needed system of user fees compatible with the goal of preserving equitable access to services.  Different countries have tried different approaches. This review examines various approaches taken by countries, but assessing their relative practical merits is difficult, as the evidence is scattered and mixed.

 Related Note (54KB PDF).  Also available in Bahasa Indonesia (142KB PDF) ◘ Español (144KB PDF) ◘ Русский (101KB PDF)