User fees were introduced by the World Bank as part of its structural adjustment program to recover costs and discourage excessive use of health services. Instead it made health services even more inaccessible to the poor by facilitating corruption and denial of care. This video resonates the adverse effects of user fees in public health services, as experienced by poor marginalised women in Bangalore. The women are often exploited to pay more than the user fee amount as a pre-condition to receiving care and those who are eligible for exemptions through the BPL card also end up paying because of the difficulties in accessing this card.
Ultimately, women have to make the difficult choice between not seeking care at all, because of cost considerations, or of choosing the private sector which is mostly unregulated, irrational and demands excessive out of pocket payments. In spite of a large body of evidence about the burden that user fees impose on the poor, India is one of the few countries that continues to hold on to this form of payment.