… but often through individual out-of-pocket payments

This reduction of state resources has led to a variety of initiatives to lever greater community contributions.

In the 1990s, many countries introduced or intensified 'cost recovery' measures, primarily through user fees. These measures claimed a number of positive outcomes for their health systems, such as:

  • increased revenue through charges on services;
  • improved coverage and quality of care through spending on service improvements;
  • enhanced equity through targeted spending on the poor;
  • improved service utilization and referral patterns through the control of 'frivolous' demand and the use of prices to direct service use;
  • increased efficiency by making providers cost conscious and encouraging cost effective techniques of providing care (Equinet Steering Committee, 1998).


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Involvement in health

"Community participation"

Financing health systems

Use of resources
Interactive exercise