User charges, snares and delusions : another look at the literature

This is one in a series of articles by the authors about the ongoing debate over user charges in the Canadian health care system. In this paper we review and extend an earlier, in-depth analysis of the effects of user charges which three of us (MLB, RGE, GLS) published in 1979. The present paper assesses whether experience and published literature in the years since then alter any of the (largely negative) conclusions of the earlier study concerning the ability of direct charges to patients to achieve important public policy objectives, including controlling health care costs.