The Impact of User Fees for Preventive Health Care ? Jamaica

This paper is the first in a series of four which examine the effects of user fees on the demand for care by clients in need of family planning, antenatal, immunization services, as well as services for hypertension and diabetes. It employed a mixed methodology ? a cohort comprising 1,017 clients in three communities followed for a period of 18 months, focus group discussions, observations by mystery clients and interviews. The results showed that measures put in place to ensure that all had access to health care failed, and that the clients who were most affected by health costs were those with chronic complaints and especially those in rural areas. Within the last few decades, Jamaica has made impressive gains in improving the health status of its population and has done so at relatively low cost. The improvements have been apparent in most of the key indicators ? life expectancy, infant and maternal mortality. However, the changing spectrum of diseases ? the shift from infectious to chronic diseases as the leading causes of morbidity and mortality, the increasing importance of HIV/AIDS and intentional and unintentional accidents and injuries ? present serious challenges to the health system, especially in the light of the macro-economic problems and their impact on the social sectors such as the Ministry of Health (MOH). Data from the Survey of Living Conditions (SLC) (2006) show that just under 15% of the population are living in poverty(Planning Institute of Jamaica 2007). Just eight% of persons in the lowest quintile have access to private insurance and those in the lower socio-economic groups are dependent on the health services provided by the public sector. As the burden of providing and sustaining the level of care increased, Jamaica was faced with a