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date: 15 May 2021

Abstract and Keywords

This article considers the use of user charges or co-payments in both developed and developing countries. It discusses a fundamental tension between controlling moral hazard and assuring access to needed services, especially amongst the very poor. This article focuses on public systems and only refers to empirical results for private insurers. It gives a brief overview of the importance of out-of pocket payments in the world and discusses the allocative effects of user charges, their implementation as a revenue-raising mechanism, and their effects on equity. It also discusses the quantitative information derived from various surveys. Finally, there is a deviation on two related phenomena: informal (even illegal) payments to providers and extra (or balance) billing, i.e. charging additional fees on top of the official fee schedule that is used for reimbursement. These raise same issues as user charges in general.

Keywords: user charges, public systems, co-payments, extra billing, informal payments

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