A route away from UHC?
You are absolutely right Jorge, in flagging the inequities associated with point-of-service fees. The President of the World Bank had a lot to say about this in his speech to the World Health Assembly last month when he said:
“The issue of point-of-service fees is critical. Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services. This is both unjust and unnecessary. Countries can replace point-of-service fees with a variety of forms of sustainable financing that don’t risk putting poor people in this potentially fatal bind. Elimination or sharp reduction of point-of-service payments is a common feature of all systems that have successfully achieved universal health coverage”
As the intention appears to be to scale up this project and therefore increase the role of point-of-service fees, how is this approach compatible with President Kim’s statement above?
Also aren’t you concerned that commission payments for these “informal health entrepreneurs” are likely to lead to supplier induced demand, resulting in poor people receiving unnecessary investigations and expensive treatments. I trust the commissions will not be based on a percentage of the final bill presented to the patient by the formal provider. Even with flat-rate commission there must be a danger that vulnerable people will be exploited by these incentives.
In your reply, you say that the equity aspects of this approach have not been evaluated yet. Might I suggest that you get on with this pretty quickly, because I fear that a health system based on this approach will take countries away from UHC.