Direct Household Payments for Health Services in Asia and the Pacific: Impact and Policy Options

Overview

Many low- and middle-income countries in Asia and the Pacific rely heavily on user fees and other direct household payments to fund health services. Such fees, in most cases, have led to reduced access to care, particularly for the poor.

This policy brief makes five policy recommendations:

• Abolishing user fees is a useful and politically palatable policy option but it must be implemented carefully with adequate alternative funding in place.
• Countries can take an incremental approach to eliminating user fees, starting with easily identifiable vulnerable population groups.
• Expanding prepayment mechanisms through general government revenues and/or social health insurance requires strong political commitment, as it implies additional funding for health.
• A good example of paying specific attention to the poor and vulnerable is replacing user fees for mothers and children with adequate budget subsidies. Other approaches include the use of vouchers or conditional cash transfers.
• More targeted approaches depend on how feasible it is to identify the poorest and most needy households, as well as institutional capacity to manage such schemes.