Creese A L
World Health Organization, Switzerland.
Health Policy Plan. 1991 Dec;6(4):309-19. doi: 10.1093/heapol/6.4.309.
This paper reviews recent experiences with increases in user charges and their effect on the utilization of health care. Evidence from several countries of differences in utilization between rich and poor is presented, and recent accounts of sharp, and often sustained, drops in utilization following fee increases, are presented and discussed. Fee income, appropriately used, represents a small but significant additional resource for health care. Recent national experiences appear to have concentrated on achieving cost recovery objectives, rather than on improving service quality and health outcomes. Appraisal of financing changes must be linked to probable health outcomes. Successful large-scale experience in linking these two is in short supply.
本文回顾了近期提高用户收费的经验及其对医疗保健利用的影响。文中呈现了几个国家关于贫富人群在医疗利用方面差异的证据，并介绍和讨论了近期有关费用增加后利用率急剧且往往持续下降的情况。适当使用的费用收入是医疗保健的一项虽小但重要的额外资源。近期各国的经验似乎都集中在实现成本回收目标上，而非改善服务质量和健康结果。对融资变化的评估必须与可能的健康结果相关联。目前缺乏将这两者联系起来的成功大规模经验。
