The concept of ascribing user fee in health care settings always remained a policy struggle and countries experienced different learning in this regards while implementing user fee at different tiers of health settings. The most exquisite learning among the many country specific evidences related to user fee are the match and mismatch between the equity principle and benefit principle while considering the client perspective. There is an added dimension of quality care which also add more complex dynamics into this concept since the quality care consideration has a double edged perspective both for clients and providers, where which one will get superiority over whom is a great question in health care, especially in the Primary Health care (PHC) of the country. In this reality the appropriate implementation guideline, followed by an appropriate practice of the administrative and management both service oriented and financial are of great importance in this user fee implementation consideration which always remained a challenge in the health care specially in remote care of PHC. This paper attempted a secondary data searching and scoping the available documents of Bangladesh and across the world to find an alternative approach to user fees policy where equity and benefit principle and quality - these three have to be placed in a well-constructed triad in PHC implementation which has been recommended as an alternative policy imperative in approaching user fees for Bangladesh PHC settings.
A Theory of User-Fee Competition