Bart Jacobs
The impact of the introduction of user fees at a district hospital in Cambodia
Documentation Center of Cambodia
proponents user fees health sector poor countries cite number often interrelated rationales relating inter alia cost recovery improved equity greater efficiency opponents argue dramatic sustained decreases service utilization follow introduction user fees highlighting evidence user fees reduce service utilization fail result improved quality care andor services priced higher charged private health care providers utilization public health services cambodia low supplyside factors significant determinants low public sector utilization including low official salaries service providers forcing many seek additional income private sector operations budgets erratic often insufficient cover running costs service delivery outlets cambodia ministry health moh encourages user fee schemes operational district level allowing revenue retained health facility level moh aims improve health care deliveryand consequently service utilizationthrough increased salaries health facility staff increases operations budgets case study introduction user fees district referral hospital kirivong operational district cambodia using findings empirical research examines impact user fees healthcareseeking behaviour ability pay consultation prices private practitioners research showed consultation fees charged private providers increased tandem price increases introduced referral hospital demonstratesfor first time aware available literaturethat introduction subsequent increase user fees created medical poverty trap significant health livelihood impact including untreated morbidity longterm impoverishment addressing medical poverty trap require two interventions implemented immediately regulation private sector reimbursing health facilities services provided patients exempted paying user fees poverty third longerterm initiative also suggested establishment social health insurance mechanism