‘Willingness to pay’

How health care user fees spread around the world, 1965–2015

Authored by: Aaron Shakow , Salmaan Keshavjee

Routledge Handbook on the Politics of Global Health

Print publication date:  December  2018
Online publication date:  December  2018

Print ISBN: 9781138238596
eBook ISBN: 9781315297255
Adobe ISBN:


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Worldwide, one of the hottest topics in public life today is health care and who should pay for it. Since at least the 1970s, it has been recognised that one way to ration access to this often-expensive social service is to charge patients at the point of service delivery. When payment is demanded up front, many people avoid the doctor’s office, even if they are sick, and the poorer they are, the more pronounced this effect. Yet for years, development specialists urged poor countries to recoup the costs of health care directly from individuals rather than relying on public financing.

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