"Voluntary" user fees in Buenos Aires hospitals: innovation or imposition?
Voluntary user fees in hospitals in Buenos Aires, which operate outside official controls, have not featured in other studies of health care in Argentina. After providing a historical overview of different hospital funding sources, the authors focus on the activity of cooperadoras--the organizations responsible for levying voluntary fees. Using detailed data from two case-study hospitals and more general financial sources, they assess the importance of these fees, identifying sharp variations between different hospitals, serious problems of under-reporting, and potential abuses. The authors also examine the means by which fees are levied and the degree of coercion involved. Voluntary fees are not a particularly successful funding strategy: the income they generate is variable; they are almost entirely unregulated; and they sometimes conflict with other, more legitimate funding sources. Most importantly, their voluntaristic aspect is largely notional: most patients are heavily pressured to make payments. The main motivation for continuing with voluntary fees is to avoid the political fallout that would probably result from introduction of a formal user fees policy.
Lloyd-Sherlock
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School of Development Studies, University of East Anglia, Norwich, England. p.lloyd-sherlock@uea.ac.uk
Novick
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D001118:Argentina; D003068:Coercion; D005377:Financial Management, Hospital / Q000379:methods* / Q000706:statistics & numerical data; D005382:Financing, Personal / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D015285:Hospital-Patient Relations; D006773:Hospitals, Municipal / Q000191:economics* / Q000706:statistics & numerical data; D007350:Insurance, Hospitalization; D009313:National Health Programs / Q000191:economics; D019982:Organizational Case Studies; D012017:Referral and Consultation / Q000191:economics