There are concerns on whether user fees in public health services are the appropriate means of improving both quality of the services and accessibility to the same. As a follow-up research, we set out a study to bring out the impact of fees on quality and attendance in health facilities in Tanzania. The study examined relevant provider and household surveys that were carried out at different points of time in order to compare changes in user fees, quality and attendance. The results suggest three major conclusions. Firstly, it is that user fees per se do not matter; rather, it is the expenditure from the user fee revenue that matters most in the decision to seek care. Secondly, there is a general indication that government grants are fungible to user fees; and as a result, the fees constitute an increase in the price of public health services. Thirdly, delivery efficiency features as the central determinant factor in the interaction between user fees, quality and usage; implying that unit costs should be considered in the process of introducing user fees.