Co-payments
The editorial in the Herald today in support of an excess charge for ACC payments is an excellent, eminently sensible article. Unfortunately, in reality, this may be a little more difficult to achieve than it looks. GP’s and A&Ms already have a part-charge for most patients, as do most radiologists. The only place where you can access emergency care for accidents completely free is the Emergency departments of public hospitals. Increasing these co-payments will still decrease further the number of people accessing ACC for trivial reasons. Unfortunately, it will also discourage those people to should be accessing treatment. Currently most of the evidence points to the fact that very few people avoid accessing medical help because of cost. This would undoubtably be because the cost of the public service is time and not financial.
Introducing a co-payment into the emergency system will have a number of undesirable effects. The first is that some will not access the ED when they really should (this figure is likely to be small unless the co-payment is large – most do not seek help because they fail to recognise the problem or they do not have access to transport). The second is that it is an added layer of complexity (cash systems, eftpos, credit cards, floats, cash registers – and skills to work all of these). The third is that it invariably generates a mountain of small bad debts that is extremely difficult to collect and is associated with a significant increase in complaints and all the concomitant paperwork. Money is the underlying root behind 50% of complaints.
Because of this, I remain somewhat doubtful of the value of a co-payment system, while acknowledging that such a system may be the only way to tackle the avalanche of trivial complaints that cross the threshold of emergency departments and A&Ms every year.
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- It burns! « The Dim-Post — [...] Filed under: Politics, blogging, health — danylmc @ 8:16 am MacDoctor is being sensible and reasonable again: ...
Oct 20 09 9:44 pm
I worked in the UK for a while, and got talking to our local GP about co-payments. He was very keen on the idea to keep the time-wasters away. We lived in a small seaside town known for its drug rehab center and its retired population. If we were sick, we had to ring and try and get a doctors appointment, and normally they couldn’t see us for a few days. They used to tell us to just come in anyway, and hope for a cancellation. They invariably got them, because
1.) with no fees at all, and no charge for no-shows, there was invariably people who just wouldn’t turn up, and wouldn’t bother to keep their appointment.
2.) With generally being unable to see a doctor for a few days (non-urgent), many people would get better while waiting.
3.) Being in a retirement village, the doctor commented that many came in to the doctor because they were lonely.
We talked about whether a simple GBP 5 charge would reduce these problems.
Oct 21 09 10:24 am
National tried something similar back in the 1990s with the ill-conceived public hospital outpatient fee.
It was hugely unpopular and there were so many people who either couldn’t pay or wouldn’t pay that it ended up with the cost of collecting the fees approaching the revenue raised from them.
They were then forced to admit it didn’t work and abolished it.
Oct 22 09 5:04 pm
Strictly speaking what they are talking about is a Deductible rather than a Co-Payment.
A co-payment is where you pay a % of the total.
Semantics though