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Support for the introduction of user-fees in public health facilities increased in developing countries in the 1980’s, including Jamaica, with institutions such as the IMF and the World Bank calling for pro-market reforms. On April 1, 2008 the Government of Jamaica reversed its policy and removed user fees for services at public hospitals, heralding a commitment to universal access to healthcare. The national debate as to whether the public purse can sustain a quality healthcare service for the benefit of the most vulnerable social groups has only been met with anecdotal evidence. This paper compiles the results of a nationwide survey of public hospitals to investigate the effect of the no-user fee policy on health services in Jamaica. The study reveals that the abolition of user fees has resulted in a loss of financial resources for the sector, negatively affecting pharmaceutical and medical supply stocks, staffing, waiting times, space, service delivery and processing time. If the policy is to be maintained it must be accompanied by reforms that address or substitute the loss of financial resources.