Fiedler J L
Independent Health Economist, Sturgeon Bay, WI 54235.
Soc Sci Med. 1993 Mar;36(6):735-47. doi: 10.1016/0277-9536(93)90034-2.
Since the early 1980s, the Ministries of Health of most Developing Countries have been plagued by significant and persistent resource shortages. One response of many Third World countries to this health financing crisis has been to turn to user fees. This article presents a case study of the evolution of public health care system fees in El Salvador in the decade of the 1980s. Since 1980 falling levels of real funding of the Ministry of Health of El Salvador have resulted in falling supplies of drugs, materials and equipment throughout the public health system, and have contributed to declining utilization levels of public health facilities. Local public health providers and their community health boards (patronatos) have responded to this crisis by creatively institutionalizing decentralized, revolving accounts based on 'voluntary' user fees for ambulatory care, collected and retained at individual facilities. This article describes the legal foundations, organization, functioning, incentive structures, financial performance, and the institutional development of El Salvador's local user fee systems.
自20世纪80年代初以来，大多数发展中国家的卫生部一直受到严重且持续的资源短缺问题困扰。许多第三世界国家应对这一卫生筹资危机的一个举措就是转向收取使用者费用。本文呈现了20世纪80年代萨尔瓦多公共卫生保健系统费用演变的一个案例研究。自1980年以来，萨尔瓦多卫生部实际资金水平下降，导致整个公共卫生系统的药品、物资和设备供应减少，并致使公共卫生设施的利用率下降。当地公共卫生服务提供者及其社区卫生委员会（patronatos）通过创造性地将基于门诊“自愿”使用者费用的分散式循环账户制度化来应对这一危机，这些费用在各个机构收取并留存。本文描述了萨尔瓦多地方使用者费用系统的法律基础、组织、运作、激励结构、财务绩效以及机构发展情况。
