User fees have existed in some Honduran Ministry of Health (MOH) facilities since the 1950s. The legal framework dating from 1989 establishes recommended fees and required procedures for an “institutional” user fee system, and allows for establishing a parallel system if there is adequate community participation in its design and operation. The MOH has sought to encourage these parallel “community” systems by not making them subject to the same rules and regulations as the institutional systems. The Ministry, however, never operationally defined “community” or “community participation.” The community systems are intended to be complementary systems, and not substitutes for the institutional systems. Hence, the MOH facilities in “communities” that have a community system generally have both types of user fee systems.
Based on a 1998 household interview survey of 4,000 households and a Y2K interview survey of 175 MOH facilities, this paper presents a comprehensive empirical analysis of Honduras’ institutional and community user fee systems. The study includes a discussion of the legal foundations, their fee levels, exoneration policies, gross and net revenues (net of administrative costs), administrative systems and the incentive structures they generate for patients and providers. The equity and efficiency of the two systems is assessed. Simulations are conducted of changes in fees to make them more consistent with stated MOH goals and objectives. Finally, the possibility of establishing a more formal and institutionalized—and thus, it is hoped, more sustainable—form of community participation, which is consistent with the Honduran Government’s decentralization plans, is examined.
Learning Objectives: At the conclusion of the sessions, the participant in the session will be able to: 1. Describe how to analyze the design, implementation, operation, monitoring and evaluation of user fee systems. 2. Assess equity and efficiency of user fee systems. 3. Articulate ways to establish more sustainble forms of community participation that are consistent with a country's decentralization plan
Keywords: Safety,
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.