Chapter 7. Health Financing Module
17. Informal user fees in the public sector a. Are informal user fees (widely) practiced in the public health sector? b. What is the typical form of informal fee payments? c. To what extent are informal user fees a financial barrier to use of services? Definition, rationale, and interpretation
Informal user fees in the public sector are fees that are not officially sanctioned, often called under-the-table payments. They can exist in the form of cash, in-kind payments, or gratuities, and are often charged for access to scarce items such as medicines, laboratory tests, and use of medical equipment. The amount of informal user fees that will be charged is difficult for patients to anticipate and can act as a barrier to care, just as formal fees do. Allocation of the revenue from informal user fees is subject to the discretion of the provider and, as opposed to revenue from official user fees, may not be used to increase the quality or access to public health services.
Suggested data source
Special studies; key informant interviews
Stakeholders to interview
Representatives of donor agencies, nongovernmental organizations (NGOs), and consumer advocacy organizations; users of health services (through focus group discussions)
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