User Fees: Friend or Foe?

By: Hina Bana

The idea of universal healthcare is being made into a reality around the globe today. Many countries have implemented a system in place for its citizens to receive healthcare services, whether through taxation or though a user fee system so citizens can access health care. Experts agree that universal health care is necessary but many argue on the advantages and disadvantages of having user fees.

User fees were introduced in many low- and middle-income countries in the 1980s with the support of UNICEF and the World Bank. User fees were expected to stop people from seeking unnecessary health care. They are also seen as a way to raise extra funds that can be used to improve the quality of health services in that country. These extra funds can also be used to expand health services and ensure that the whole population gets access to health care (Lagarde, M., & Palmer, N. 2011). Systems with user fees have seen a deduction in services, making people think that its better in keeping the cost of health care low in countries that have user fees. Secondly, countries seem to favor the user fees since it helps motive the staff to provide better services, pay for staff incentives, and creates a sense of ownership within the community. (Ir, P., & Biddeli, M.  2009).

On the opposing side, many believe that user fees keep those less privileged from seeking treatment due to funds. For example, in Sudan 70% of people in disadvantaged areas who did not seek care when sick reported scarcity of money as the reason for not accessing services (Yates 2009). In countries where the priorities lie in putting food on the table, getting their children an education, or day to day survival sometimes healthcare isn’t seen as a priority. Many countries are taking it upon themselves to remove user fees. For example, in Uganda in 2001, the president removed all health user fees in public facilities with the exception of a few private wings in some tertiary hospitals. The number of outpatient visits rose immediately and increased rates of use have been sustained.

While I respect the views of both sides, I feel that in order for universal healthcare to be accessible to everyone there needs to be no user fees. When we start charging people for a services that only the middle to upper class can afford we limit the people who have access to the service. The idea of universal is that it needs to be just that, universal in nature, and available to everyone regardless or not if they use it. By eliminating user fees, Yates’s research shows that we increase the number of people who can attain healthcare services, while in the past they weren’t able to afford it (Yates 2009). Its my personal belief that those without wouldn’t “abuse” or “over-use” a system like UNICEF and the World Bank believe but just use it for what they need (Lagarde, M., & Palmer, N. 2011). When people are healthy and productive members of society they are able to take better care of their families, be better citizens to their countries and live more independent lives.

Universal healthcare is a reality occurring in many countries, the debate on how to construct a system that works is still on going. There are pros and cons to the issue but at the end of the day the goal is to have healthily members of society. I believe that without user fees more people are able to attain access to healthcare services and lead healthier and longer lives and not just those with the economic resources available. It is up to the countries with the need and desire to have non user fees to speak up and communicate to those in charge only then will the less fortunate be able to attain healthcare services in all countries.


Ir, P., & Biddeli, M. (2009). Removal of user fees and universal health-care coverage., 374, 608.

Lagarde, M., & Palmer, N. (2011). The impact of user fees on access to health services in low and middle income countries (Review). The Cochrane Library, Vol:4, 1-70.

Yates, R. (2009). Universal health care and removal of user fees., 373, 2078-81.


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One response to “User Fees: Friend or Foe?

  1. Pingback: User fee removal in the health sector in low-income countries: lessons from recent national initiatives « kracktivist

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