http://www.cid.harvard.edu/cidwp/pdf/081.pdf

The paper provides evidence from the literature that in most instances user fees had the unintended effect of decreasing access to health care by the poor. It argues that user fees, in addition to having been largely unsuccessful in raising significant resources, greatly contributed to increasing the exposure of poor households to the financial risks associated with illness. A major conclusion is that alternate financing mechanisms are required to provide financial risk protection to low-income households, particularly to those in the informal sector. (Au)