We develop a two-region model where the decentralized provision of spillover goods can be financed by means of taxes or user fees. In order to enforce the fees regions have to invest in exclusion. We show that a decentralized solution tends to be inefficient. There will be over-investment in exclusion and an underprovision of the spillover goods compared to a centralized solution. In addition t...

BACKGROUND Since the advent of health user fees in low- and middle-income countries in the 1980s, the discourse of global health actors (GHAs) has changed to the disadvantage of this type of healthcare financing mechanism. The aim of the study was to identify and analyze the stance of GHAs in the debate on user fees. METHODS We conducted documentary research using public documents published b...

User fees can contribute to the financial sustainability of marine protected areas (MPAs), yet they must be acceptable to users. We explore changes in the fee system and management of Bonaire National Marine Park (BNMP) from the perspective of users. Responses from 393 tourists indicated that 90% were satisfied with park conditions and considered current user fees reasonable. However, only 47% ...

The World Bank and International Monetary Fund favor healthcare user fees. User fees offer revenue and may decrease inappropriate care. However, user fees may deter needed care, especially in vulnerable populations. A cross-sectional analysis of healthcare utilization in a large Zambian hospital was conducted for children 3-6 years of age during a 1-month observation period. Diagnoses and treat...

There is currently considerable discussion between governments, international agencies, bilateral donors and advocacy groups on whether user fees levied at government health facilities in poor countries should be abolished. It is claimed that this would lead to greater access for the poor and reduce the risks of catastrophic health expenditures if all other factors remained constant, though oth...

OBJECTIVES Vietnam started its health reform process two decades ago, initiated by economic reform in 1986. Economic reform has rapidly changed the socio-economic environment with the transition from a centrally planned economy to a market-oriented economy. Health reform in Vietnam has been associated with the introduction of user fees, the legalization of private medical practices, and the com...

1990’s were marked by massive introduction of user fee health care plans as a mean of improving efficiency by moderating demand, containing cost, and mobilize more funds for health care than existing sources provided. Introduction of user fees raised a lot of controversy with common claims that their implementation reinforced the poverty trap in developing world, which has considerable health a...

This chapter is concerned with the issue of user fees (or user charges) for public health services. We discuss the implications of user fees for cost-e¤ectiveness, allocative e¢ ciency, equity, progressivity of public health care spending, and quality of service. Each of these is a desirable end in itself, and so each is an important factor in the optimal pricing decision. They are not always c...