This paper employs the Slutsky decomposition of the effect of price change to identify impacts of user fees on access to public health care. The paper starts with a theoretical outline that relates user fees to quality of health care before carrying out the Slutsky decomposition to identify the income and substitution effects of user fees in public health care. Delivery deficiency is observed as an important factor that shapes the impact of user fees on demand for health care. The findings suggest that introduction of user fees in public health care without appropriate measures to boost quality of the services may have negative effects on demand. Thus, delivery efficiency of public health services matters as it fuels the effect of a price change.