Ellis R P
Economics Department, Boston University, MA 02215.
Soc Sci Med. 1987;25(9):995-1002. doi: 10.1016/0277-9536(87)90004-9.
This paper develops and implements a methodology for estimating the total revenue that would result from a system of user fees for health services provided by public facilities in a developing country. After setting out a set of principles based on efficiency, equity, and administrative goals upon which the user fees should be founded, a formula for estimating total revenue generated is presented which reflects six different factors affecting total revenues. These factors include reductions in demand due to imposing fees, exemption of selected services from any fees, forgiving fees from those unable to pay, and 'leakage' of revenue due to bribes, etc. Three specific fee structures are then examined for Kenya, and the total revenue to be generated is predicted. The revenue totals are large, on the order of 10-22% of the government's total recurrent health costs, suggesting that even modest user fees can make a significant contribution to public health costs.
本文开发并实施了一种方法，用于估算发展中国家公共设施提供的卫生服务使用者付费制度可能产生的总收入。在阐述了一套基于效率、公平和管理目标的使用者付费应遵循的原则之后，给出了一个估算总收入的公式，该公式反映了影响总收入的六个不同因素。这些因素包括因收费导致的需求减少、某些服务免收任何费用、免除无力支付者的费用以及因贿赂等导致的收入“流失”。然后研究了肯尼亚的三种具体收费结构，并预测了可能产生的总收入。总收入数额巨大，约占政府经常性卫生总费用的10%-22%，这表明即使是适度的使用者付费也能对公共卫生费用做出重大贡献。
