The political economy of user fees with targeting: developing equitable health financing policy: Developing equitable health financing policy

Proponents of user fees stress that equity and efficiency gains can be achieved through the implementation of a cost-recovery policy package. Within this package user fees are complemented by decentralization and combined with two targeting mechanisms favouring low income groups: exemptions, and the use of fee revenue to improve the services offered to them. This paper seeks to contribute to health financing policy debates by reviewing targeting options and assessing the available evidence concerning these issues. Success in protecting the poor appears to be limited and there are considerable informational, administrative, resource and socio-political constraints undermining the development of effective targeting mechanisms. The paper, therefore, urges caution in developing health care financing policy and identifies a relevant research agenda. -from Authors