User fees in public facilities : a comparison of experience in the Dominican Republic, Honduras and Jamaica

Reduced resources for meeting national health goals, in both real and nominal terms, are a pattern familiar across the region. Given the seriousness of the resource constraints, governments and their health ministries face three possible strategic options: (1) to tolerate a deterioration in the quality, quantity, and coverage of health services; (2)to look for mechanisms to improve efficiency and increase productivity; and (3) to search for new sources of revenue. Most countries are likely to use some combination of all of these options. Empirical data collected from the public health systems of the Dominican Republic, Honduras, and Jamaica offer a comparison and contrast of the relative merits of the third option in responding to the financial crisis. The public health systems in these three countries have long subscribed to the philosophy that health care is a right and that the state should provide free public services to meet the health needs of the population. Yet within this approach, all have tolerated fee-for-service charges for some services and for certain categories of clients. The purpose of this paper is to compare and contrast the operational experiences of these countries with the collection of user fees in public hospitals. Our intent is to contribute to a body of relevant and systematic information which can be used to establish realistic expectations and guidelines for user-fee systems. (Author abstract, from PN-ABY-621)