The development of functional health financing systems in low and middle-income countries holds a vital role in the movement towards improved, equitable access to affordable healthcare services. Yates (2009) presents a solution through the removal of user fees, which have proved to produce lower usage of healthcare services and a disproportionate reduced demand for healthcare by poor people. Initially put into effect with the intent to raise additional revenue, user fees made up only 6-9% of the public health budget of a review of nineteen African countries in 2004, and also involve high administration costs, a lack of movement towards usage of cost-effective services, and increased disadvantages towards the poor through deterrence in accessing healthcare services (Yates, 2009).
Yates (2009) raises this notion of the necessity of removing any deterrence (such as user fees) of utilization of healthcare services in order to improve health status in developing countries. Healthcare services must be widely available, but also must be actively used and accessed by all levels of a population. Yet, we read in Leive and Xu (2008) of the significant economic, social, and family consequences of illness and out-of-pocket health payments for inpatient and outpatient healthcare in fifteen African countries. Without a formal health insurance system, families often must sell assets, spend savings, and borrow from others in the community, mostly done in an informal setting and to the extent of the social capital of a family. Family members previously not working may be forced to seek employment in order compensate for lost income, and children may even be removed from school in order to contribute financially.
The comparison of these concepts from the two articles struck me – in which obstacles to access of healthcare services must be removed in order to promote usage, but we then review the various levels of consequences that usage of such services can have on families in developing countries. As a teenager, my father was diagnosed with advanced cancer, which proved to be financially costly to my family even with full insurance coverage. We depended on extended family members and friends for meals, transportation and care for me and my siblings, and support. The experience of “health shocks” within my family and others in the United States obviously differs greatly from those in developing countries, yet, within these two contexts, the basic devastating effects to the family can be similar through such aspects as potential loss of income, emotional and physical stress, and the altering of family dynamics. A clear need for some level of a social and financial health protection system in developing countries is evident in order to reduce the effects of illness and out-of-pocket health payments on poverty levels (Leive & Xu, 2008).
Lieve, A., & Xu, K. (2008). Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bulletin of World Health Organization, 86(11), 849-856.
Yates, R. (2009). Universal health care and the removal of user fees. The Lancet, 373, 2078-2081.