Mwabu G M, Mwangi W M
Soc Sci Med. 1986;22(7):763-7. doi: 10.1016/0277-9536(86)90228-5.
This paper examines the efficiency and equity effects of introducing user fees in public health facilities in Kenya. These effects are studied with the aid of a simulation technique. It is found that through their favourable effects on quality of medical services, the user fees in public clinics would yield welfare gains. However, these gains might involve unacceptable equity trade-offs. Thus, in general, the net welfare effects of user charges on medical services is ambiguous. More specifically, if the user fees were imposed across the board in government health facilities, the equity trade-offs would be large, and for that reason, the user fees would be socially and politically unacceptable. But, if the user charges are restricted to government hospitals, the attendant equity problem would not be too difficult to manage.
本文研究了在肯尼亚的公共卫生机构引入使用者付费制度所产生的效率和公平效应。借助模拟技术对这些效应展开研究。研究发现，公立诊所的使用者付费制度因其对医疗服务质量的有利影响，将带来福利收益。然而，这些收益可能涉及不可接受的公平权衡。因此，总体而言，医疗服务使用者付费的净福利效应并不明确。更具体地说，如果在政府卫生机构全面推行使用者付费制度，公平权衡将十分巨大，正因如此，使用者付费制度在社会和政治层面将无法被接受。但是，如果将使用者付费限制在政府医院，随之产生的公平问题将不会太难处理。
