A Review of the Appropriateness of User Fees and Social Health Insurance to Fund the Health Care Systems in Low and Middle-Income Countries
Background: User fees and social health insurance (SHI) are key strategies of healthcare funding. These strategies which have been widely adopted in low and middle-income countries have been shown to be rarely beneficial to poor people. There has been doubt on their capability to facilitate improved access to healthcare services especially for the poor. Hence, this paper discusses the appropriateness of user fees and SHI in the funding of healthcare systems by critically appraising their strengths and weaknesses. It will also draw attention of government to alternative methods that can help deal with healthcare funding especially for the poor population.
Materials and Methods: A search of some standard books and relevant articles on the appropriateness of user fees and social health insurance to fund health systems was carried out using the Google, Yahoo search engine, EMBASE and OVIDMEDLINE data bases.
Results: The main goal of a healthcare system is to improve the health of the whole population and meet the key needs of the healthcare system. User fees have been described as the most regressive way to pay for health. In countries where SHI is the predominant source of funding the poor people are likely to be excluded from participating because they do not have regular employment for meeting regular payments.
Conclusion: User fees and SHI funding mechanisms seem inappropriate to fund healthcare systems of low and middle-income countries because of extreme poverty. Governments should explore other alternative methods of healthcare funding that can help tackle healthcare funding especially for the poor population
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