Advocacy against monopolies and the centralized distribution of inputs such as essential drugs has been an important focus of PBF. Governments should not maintain a single central medical stores distribution system but should also encourage the private sector to enter the market. This competition should be well regulated to ensure product quality. Monopolies tend to create shortages, reduce consumer friendliness, and waste public resources.

A second “hot” topic is the wisdom of generalized free health care systems. It is extremely expensive and tends to lead to poor quality services. When proposing free services, the question is: where will sufficient (financial) resources come from? Microeconomic theory explains that ceiling prices for goods or services below market price lead to black-market effects, a demotivated workforce, and consumer unfriendliness.

Another debate concerns PBF and equity. When resources are sufficient, PBF can help the vulnerable through equity instruments, such as targeting additional subsidies to vulnerable regions, health facilities, and individuals.

Nobody likes to pay user fees or insurance premiums, but in most countries they are necessary to ensure sufficient resources for quality health services. Households should contribute proportionally to their income, and this proportion may be set at around 8-12%. In low- and low-middle-income countries, the most efficient manner is to set user fees and premium prices at the health facility level. At the same time, safety nets should be put in place to protect the vulnerable. The proportion of vulnerable people may vary depending on the available public resources. In Cameroon, the proportion was set at 10%, while in Mali it was set at 25% because of the higher poverty level.