fees and charges


Summary: Amounts charged to the patient as payer for health care services.

Top Publications

  1. Bertakis K, Azari R, Helms L, Callahan E, Robbins J. Gender differences in the utilization of health care services. J Fam Pract. 2000;49:147-52 pubmed
    ..Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care. ..
  2. Kajula P, Kintu F, Barugahare J, Neema S. Political analysis of rapid change in Uganda's health financing policy and consequences on service delivery for malaria control. Int J Health Plann Manage. 2004;19 Suppl 1:S133-53 pubmed
  3. Xu K, Evans D, Kadama P, Nabyonga J, Ogwal P, Nabukhonzo P, et al. Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc Sci Med. 2006;62:866-76 pubmed
  4. Witter S, Arhinful D, Kusi A, Zakariah Akoto S. The experience of Ghana in implementing a user fee exemption policy to provide free delivery care. Reprod Health Matters. 2007;15:61-71 pubmed
    ..At the end of 2005, a national health insurance scheme, intended to include full maternal health care cover, was starting up in Ghana, and it was not yet clear how the exemptions scheme would fit into it. ..
  5. Fisher C. Multifactor productivity in physicians' offices: an exploratory analysis. Health Care Financ Rev. 2007;29:15-32 pubmed
    ..For 1993-2000, physicians' office MFP growth was both negative and below general economy rates. For the most recent period analyzed, 2001-2004, physician's office MFP grew nearly as quickly as the general economy. ..
  6. Newhouse J, Sinaiko A. Productivity adjustment in the Medicare physician fee schedule update. Health Care Financ Rev. 2007;29:5-14 pubmed
    ..This article also shows productivity changes varied widely across manufacturing industries, so that the use of an average across the economy or even across service industries could have substantial error for physician services. ..
  7. Ridde V, Morestin F. A scoping review of the literature on the abolition of user fees in health care services in Africa. Health Policy Plan. 2011;26:1-11 pubmed publisher
    ..We draw lessons from these experiences and suggest avenues for future research. ..
  8. Tambor M, Pavlova M, Woch P, Groot W. Diversity and dynamics of patient cost-sharing for physicians' and hospital services in the 27 European Union countries. Eur J Public Health. 2011;21:585-90 pubmed publisher
    ..A close communication with the public is needed to clarify the objectives and content of a patient payment policy in a country. ..
  9. Ridde V, Yaogo M, Kafando Y, Sanfo O, Coulibaly N, Nitiema P, et al. A community-based targeting approach to exempt the worst-off from user fees in Burkina Faso. J Epidemiol Community Health. 2010;64:10-5 pubmed publisher

More Information


  1. De Allegri M, Ridde V, Louis V, Sarker M, Tiendrebéogo J, Ye M, et al. Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso. Health Policy. 2011;99:210-8 pubmed publisher
    ..Investments in policies to address barriers beyond financial ones are urgently needed. ..
  2. McPake B, Brikci N, Cometto G, Schmidt A, Araujo E. Removing user fees: learning from international experience to support the process. Health Policy Plan. 2011;26 Suppl 2:ii104-117 pubmed publisher
    ..The authors conclude that countries that intend to remove user fees can maximize benefits and avoid potential pitfalls through the utilization of the approach and tools described. ..
  3. Meessen B, Hercot D, Noirhomme M, Ridde V, Tibouti A, Tashobya C, et al. Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries. Health Policy Plan. 2011;26 Suppl 2:ii16-29 pubmed publisher
    ..We contend that national policy-makers and international agencies could better collaborate in this respect. ..
  4. Lagarde M, Palmer N. The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence?. Bull World Health Organ. 2008;86:839-848 pubmed
    ..There is a need for more high-quality research examining the effects of changes in user fees for health services in low- and middle-income countries. ..
  5. Nabyonga Orem J, Mugisha F, Kirunga C, Macq J, Criel B. Abolition of user fees: the Uganda paradox. Health Policy Plan. 2011;26 Suppl 2:ii41-51 pubmed publisher
    ..Out-of-pocket expenditure remains high and mainly affects the poorer population quintiles. A dual system seems to have emerged where wealthier population groups are switching to the private sector. ..
  6. Nimpagaritse M, Bertone M. The sudden removal of user fees: the perspective of a frontline manager in Burundi. Health Policy Plan. 2011;26 Suppl 2:ii63-71 pubmed publisher
    ..This analysis, performed from the frontline perspective, clarifies the importance of a rigorous planning of any reform, as well as of involving peripheral actors and understanding the complex challenges that they face. ..
  7. Ponsar F, van Herp M, Zachariah R, Gerard S, Philips M, Jouquet G. Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali. Health Policy Plan. 2011;26 Suppl 2:ii72-83 pubmed publisher
    ..This would contribute to increasing the impact of interventions on population health and, in turn, the effectiveness of aid. ..
  8. Lagarde M, Barroy H, Palmer N. Assessing the effects of removing user fees in Zambia and Niger. J Health Serv Res Policy. 2012;17:30-6 pubmed publisher
    ..The comparison of these reforms in two countries also sheds light on the potentially different ways in which free care can be used as a tool to improve access. ..
  9. Nabyonga Orem J, Karamagi H, Atuyambe L, Bagenda F, Okuonzi S, Walker O. Maintaining quality of health services after abolition of user fees: a Uganda case study. BMC Health Serv Res. 2008;8:102 pubmed publisher
    ..However, a trade-off between residual perceptions of reduced service quality, and the welfare gains from removal of user fees should guide such a policy change. ..
  10. Masiye F, Chitah B, McIntyre D. From targeted exemptions to user fee abolition in health care: experience from rural Zambia. Soc Sci Med. 2010;71:743-50 pubmed publisher
    ..Our findings strongly suggest that fee removal is more effective than fragmented efforts to target exemptions to certain groups in providing protection against the financial consequences of using health services. ..
  11. Dao H, Waters H, Le Q. User fees and health service utilization in Vietnam: how to protect the poor?. Public Health. 2008;122:1068-78 pubmed publisher
    ..This cannot be done without taking measures to improve the quality of care and promote ethical standards in health care, including the elimination of unofficial payments. ..
  12. Kruk M, Mbaruku G, Rockers P, Galea S. User fee exemptions are not enough: out-of-pocket payments for 'free' delivery services in rural Tanzania. Trop Med Int Health. 2008;13:1442-51 pubmed publisher
    ..Novel approaches to financing maternal health services, such as subsidies for transport and care from private providers, are required to reduce the cost barriers to attended delivery. ..
  13. Casey M, Knott A, Moscovice I. Medicare minus choice: the impact of HMO withdrawals on rural Medicare beneficiaries. Health Aff (Millwood). 2002;21:192-9 pubmed
  14. Dowd B, Feldman R, Coulam R. The effect of health plan characteristics on Medicare+ Choice enrollment. Health Serv Res. 2003;38:113-35 pubmed
    ..Bidding behavior by plans in the Medicare Competitive Pricing Demonstration supports this conclusion. ..
  15. Dong H, Kouyate B, Cairns J, Mugisha F, Sauerborn R. Willingness-to-pay for community-based insurance in Burkina Faso. Health Econ. 2003;12:849-62 pubmed
    ..The beneficiaries of CBI should be enrolled at the level of households or villages in order to protect vulnerable groups such as women, elders and the poor. ..
  16. Buchmueller T. The health plan choices of retirees under managed competition. Health Serv Res. 2000;35:949-76 pubmed
  17. Gilson L, Kalyalya D, Kuchler F, Lake S, Oranga H, Ouendo M. The equity impacts of community financing activities in three African countries. Int J Health Plann Manage. 2000;15:291-317 pubmed
    ..The experience across countries also highlights the unresolved question of whether equity is concerned with the greatest good for the greatest number or with promoting the interests of the most disadvantaged. ..
  18. Wilkinson D, Gouws E, Sach M, Karim S. Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa. Bull World Health Organ. 2001;79:665-71 pubmed
    ..Governments should remain vigilant about the effects of new health policies in order to ensure that objectives are being met. ..
  19. Kipp W, Kamugisha J, Jacobs P, Burnham G, Rubaale T. User fees, health staff incentives, and service utilization in Kabarole District, Uganda. Bull World Health Organ. 2001;79:1032-7 pubmed
    ..Other factors may also have been influential, such as an improved drug supply to health facilities and increased public identification with community projects in remote areas. ..
  20. Strombom B, Buchmueller T, Feldstein P. Switching costs, price sensitivity and health plan choice. J Health Econ. 2002;21:89-116 pubmed
    ..Simulations combining our results with actuarial data illustrate the cost implications of risk-related differences in price elasticity. ..
  21. Conrad D, Sales A, Liang S, Chaudhuri A, Maynard C, Pieper L, et al. The impact of financial incentives on physician productivity in medical groups. Health Serv Res. 2002;37:885-906 pubmed
    ..05) and smaller in magnitude. The group-level financial incentive does not appear to be significantly related to physician productivity. Individual physician incentives based on own production do increase physician productivity. ..
  22. Hill J, Kazembe P. Reaching the Abuja target for intermittent preventive treatment of malaria in pregnancy in African women: a review of progress and operational challenges. Trop Med Int Health. 2006;11:409-18 pubmed
    ..There is however urgent need to better document best practices and lessons as a basis for developing simplified guidelines for dissemination to countries embarking on IPT implementation. ..
  23. Dong H, Kouyate B, Cairns J, Sauerborn R. Differential willingness of household heads to pay community-based health insurance premia for themselves and other household members. Health Policy Plan. 2004;19:120-6 pubmed
    ..WTP information can assist decision makers with the complex problem of choosing the enrollment unit and setting the premium. ..
  24. Palmer N, Mueller D, Gilson L, Mills A, Haines A. Health financing to promote access in low income settings-how much do we know?. Lancet. 2004;364:1365-70 pubmed
    ..Larger scale, upfront funding for evaluation of health financing initiatives is necessary to ensure an evidence base that corresponds to the importance of this issue for achieving development goals. ..
  25. Marai L, Kewibu V, Kinkin E, Peter Peniop J, Salini C, Kofana G. Remuneration disparities in Oceania: Papua New Guinea and Solomon Islands. Int J Psychol. 2010;45:350-9 pubmed publisher
  26. Baird S, Garfein R, McIntosh C, Ozler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012;379:1320-9 pubmed publisher
  27. McConnell K, Gray D, Lindrooth R. The financing of hospital-based emergency departments. J Health Care Finance. 2007;33:31-52 pubmed
    ..We identify perverse payment incentives in terms of quality, efficiency, and broad system goals, and consider how payment incentives can be used to improve patient safety and quality of care. ..
  28. Franic D, Bothe A, Bramlett R. A welfare economic approach to measure outcomes in stuttering: comparing willingness to pay and quality adjusted life years. J Fluency Disord. 2012;37:300-13 pubmed publisher
  29. Cameron M, Newman P, Roungprakhon S, Scarpa R. The marginal willingness-to-pay for attributes of a hypothetical HIV vaccine. Vaccine. 2013;31:3712-7 pubmed publisher
    ..Future acceptability studies of hypothetical HIV vaccines should use more finely grained biomedical attributes, and could also improve the external validity of results by including more levels of the cost attribute. ..
  30. Dahlén L, Lagerkvist A. Pay as you throw: strengths and weaknesses of weight-based billing in household waste collection systems in Sweden. Waste Manag. 2010;30:23-31 pubmed publisher
    ..Nevertheless, the majority of waste management professionals were convinced that recycling had increased as a result of the billing system. A number of contradicting strengths and weaknesses of weight-based billing were revealed. ..
  31. Slavitt A, Ostler D. In defense of data. UnitedHealth Group's Ingenix, says data collection unbiased, makes system better. Mod Healthc. 2008;38:46 pubmed
  32. Bearns L. The nurse as expert witness. Fla Nurse. 2007;55:17 pubmed
  33. Huo X, Shi G, Li X, Lai X, Deng L, Xu F, et al. Knowledge and attitudes about Ebola vaccine among the general population in Sierra Leone. Vaccine. 2016;34:1767-72 pubmed publisher
    ..Measures are still needed to promote the Ebola vaccine awareness and knowledge updating. Free or low-priced vaccine could increase the vaccination acceptability of the general community population significantly. ..
  34. Wendt C, Agartan T, Kaminska M. Social health insurance without corporate actors: changes in self-regulation in Germany, Poland and Turkey. Soc Sci Med. 2013;86:88-95 pubmed publisher
    ..In Poland and Turkey, on the other hand, reforms have maintained the status quo in terms of the strong regulatory, budgetary, and managerial powers of the state and very limited involvement of corporate actors. ..
  35. Dhingra N. International challenges of self-sufficiency in blood products. Transfus Clin Biol. 2013;20:148-52 pubmed publisher
    ..In 2011, experts from WHO addressed the urgent need to establish strategies and mechanisms for achieving this goal. A summary of these recommendations is further discussed. ..
  36. Okeke E, Adepiti C, Ajenifuja K. What is the price of prevention? New evidence from a field experiment. J Health Econ. 2013;32:207-18 pubmed publisher
    ..These results offer compelling evidence that the optimal set of subsidies to increase take-up of preventive testing in developing countries, must include subsidies towards treatment costs (in addition to price subsidies). ..
  37. Seiberling K, Hiebert J, Nyirady J, Lin S, Chang D. Cost of allergy immunotherapy: sublingual vs subcutaneous administration. Int Forum Allergy Rhinol. 2012;2:460-4 pubmed publisher
  38. Petch J, Dhalla I, Henry D, Schultz S, Glazier R, Bhatia S, et al. Public payments to physicians in Ontario adjusted for overhead costs. Healthc Policy. 2012;8:30-6 pubmed
    ..Conversely, hospital-based specialties such as anaesthesia, radiation oncology and emergency medicine rank significantly higher after overhead is included. ..
  39. Holloway R, Mooney C, Getchius T, Edlund W, Miyasaki J. Invited Article: Conflicts of interest for authors of American Academy of Neurology clinical practice guidelines. Neurology. 2008;71:57-63 pubmed publisher
    ..More research is needed to improve the methods to identify and quantify the types of conflicts and their potential biasing effects on selecting guideline topics, grading research evidence, and formulating practice recommendations. ..
  40. Gerber R, Charpentier M, Tecun S, Massi M, Diaz J, De Groot A. Place to be healthy: blueprint for a new free clinic for the medically uninsured of Rhode Island. Med Health R I. 2008;91:105-8 pubmed
  41. Ridde V, Haddad S. Abolishing user fees in Africa. PLoS Med. 2009;6:e1000008 pubmed publisher
  42. Lubowitz J, Appleby D. Cost-effectiveness analysis of the most common orthopaedic surgery procedures: knee arthroscopy and knee anterior cruciate ligament reconstruction. Arthroscopy. 2011;27:1317-22 pubmed publisher
    ..Sensitivity analysis shows that our results are robust (relatively insensitive) to variations in costs or outcomes. Knee arthroscopy and knee ACL reconstruction are very cost-effective. ..
  43. Shahrawat R, Rao K. Insured yet vulnerable: out-of-pocket payments and India's poor. Health Policy Plan. 2012;27:213-21 pubmed publisher
    ..A broader coverage of benefits, to include medicines and outpatient care for the poor and near poor (i.e. those just above the poverty line), is necessary to achieve significant protection from impoverishment. ..
  44. Seston E, Hassell K, Ferguson J, Hann M. Exploring the relationship between pharmacists' job satisfaction, intention to quit the profession, and actual quitting. Res Social Adm Pharm. 2009;5:121-32 pubmed publisher
    ..However, only a relatively small proportion of pharmacists who expressed an intention to leave the profession appeared to have done so, suggesting that intentions may not be translated into action in this group of pharmacists. ..
  45. Israel S. How social policies can improve financial accessibility of healthcare: a multi-level analysis of unmet medical need in European countries. Int J Equity Health. 2016;15:41 pubmed publisher
    ..Moreover, categorical policies should address households exposed to debt which form the key vulnerable group within the low-income classes. ..
  46. Maini R, Van den Bergh R, van Griensven J, Tayler Smith K, Ousley J, Carter D, et al. Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study. BMC Health Serv Res. 2014;14:504 pubmed publisher
    ..Future work should focus on feasibility issues associated with the removal or reduction of user fees and how to sustain its effects on utilisation in the longer term. ..
  47. Basaza R, Criel B, Van der Stuyft P. Community health insurance in Uganda: why does enrolment remain low? A view from beneath. Health Policy. 2008;87:172-84 pubmed publisher
    ..The study provides relevant elements for the design of a national policy on CHI in Uganda and other sub-Saharan countries. ..
  48. Wilson J. Community and family: a personal perspective on the past and future of veterinary science. Aust Vet J. 2008;86:71-3 pubmed publisher
  49. Branch D, Silver R. Managing the primary cesarean delivery rate. Clin Obstet Gynecol. 2012;55:946-60 pubmed publisher
  50. Chankova S, Sulzbach S, Diop F. Impact of mutual health organizations: evidence from West Africa. Health Policy Plan. 2008;23:264-76 pubmed publisher
    ..However, MHO membership does not appear to have a significant effect on out-of-pocket expenditures for curative outpatient care. ..
  51. Sommers A, Cunningham P. Medical bill problems steady for U.S. families, 2007-2010. Track Rep. 2011;:1-5 pubmed
    ..And, in 2010, many people in families with problems paying medical bills continued to experience severe financial consequences, with about two-thirds reporting problems paying for other necessities and a quarter considering bankruptcy. ..
  52. Lawson M. Supply side change... More to it than meets the eye!. Tenn Med. 2008;101:27 pubmed
  53. Durr S, Mindekem R, Kaninga Y, Doumagoum Moto D, Meltzer M, Vounatsou P, et al. Effectiveness of dog rabies vaccination programmes: comparison of owner-charged and free vaccination campaigns. Epidemiol Infect. 2009;137:1558-67 pubmed publisher
    ..Public health officials can use these results when evaluating the costs and benefits of subsidizing dog rabies vaccination programmes. ..