Does a pay-to-use health-care system discourage use?

[JAStewart]

As a male, I hardly ever go to the doctor. As a Scot, I don't have to pay for any health-care, yet I still don't see the GP.

I'd consider myself a soft-libertarian, or libertarianish - but I can't really abandon the NHS in my head.

I can't help but think that if people had to pay for they wouldn't get routine check ups - potentially allowing for things like HIV to spread more efficiently.

Are there any statistics on attendance figures for U. S. Citizens vs Sweden or UK or such?

 

[Tricky]

Probably, in some people. It also discourages abuse of a "free" system by hypochondriacs.

 

[Ziggurat]

I can't help but think that if people had to pay for they wouldn't get routine check ups - potentially allowing for things like HIV to spread more efficiently.

Well, you can get free HIV testing in many places in the US, so that's out. But I'm not sure your conclusion necessarily follows. I have to pay for oil changes on my car, but I get those oil changes regularly. Why? Because I have to pay even more if I don't. Similarly, the risks of developing a serious health problem that one would have to pay for may motivate some people to get checkups even when they have to pay for the checkups, whereas if you don't have to pay if you do develop a problem, you might be more inclined to not bother getting a checkup. So it's not obvious at all which direction the net pressure is.

Are there any statistics on attendance figures for U. S. Citizens vs Sweden or UK or such?

There are many other potential factors involved, so I'm not sure you could extract the answer you're looking for even with those statistics.

 

[Dymanic]

I can't help but think that if people had to pay for they wouldn't get routine check ups - potentially allowing for things like HIV to spread more efficiently.

Are there any statistics on attendance figures for U. S. Citizens vs Sweden or UK or such?

Does it really need confirmation by statistics? Seems trivially obvious to me, on the simplest of logic, that taking care of their health is a low priority for a great many people. When they finally end up flat on their backs with something requiring a pound of cure where an ounce of prevention would have sufficed, their priorities tend to change in a hurry -- but by then they have either bankrupted themselves or (more likely) placed a large and unnecessary burden on society. Some of them wouldn't seek routine care even if it were free. Their last words are usually something like, "I'm fine, really".

 

[lomiller]

Probably, in some people. It also discourages abuse of a "free" system by hypochondriacs.

How many of those are there compared to people who put off going to see a doctor when they really should?

Which costs more, a 30 min consultation for someone who isn't ill or major surgery for something easily treated if caught early?


In my experience people don’t want medical care unless they really need it, so providing a disincentive to making use of medical care is pointless. On the other hand the benefits for both coast and outcome of early diagnosis and treatment are well documented so systems that promote this will yield better results for less money.

 

[JAStewart]

A consultation would not last 30 minutes. My most recent consultation lasted, oh, around 80 seconds, and that is perhaps even an over estimate. Honestly.

 

[T.A.M.]

Interesting topic and interesting questions.

1. I think both points are valid. Pay to use MAY cause some people to avoid regular check ups, etc... Also, I believe such a system would decrease the inappropriate or excessive use of the system.

For example, what some have suggested here in Canada to help cut down on over utilization, or inappropriate utilization of the health care system is a surcharge. This would allow you, for example, to have so many trips to the ER per year free, as well as unlimited free care if the visit is for what is deemed to be "life threatening". However, if you exceed the allotted visits, and it is not life threatening, you are charged a certain percentage of the bill, or a certain fixed amount for the visit.

2. Here in Canada, the length of the visit, except for the case of psychotherapy, is irrelevant. A doctor is either (A) salaried, which means he gets paid a fixed annual salary regardless of # patients seen or length of time with each one, or (B) is Fee-For-Service, which means (in Canada at least) that he gets paid the same fee (usually $27-$40) whether he spends 5 minutes or 30 minutes with you.

TAM

 

[ARubberChickenWithAPulley]

1. I think both points are valid. Pay to use MAY cause some people to avoid regular check ups, etc... Also, I believe such a system would decrease the inappropriate or excessive use of the system.

I can only speak for myself here, but my health insurance covers preventative care (one physical a year, for example, and some other stuff) 100% -- and I've never used it once. The reason is simple: I'm young, healthy, and really don't have time to go to the doctor in the middle of the day. And almost no doctors seem to have after-work hours. Seems like it would be a no-brainer for some doctors to stay open past 5 pm, but none around me do that. Sounds like a silly reason to not take advantage of a free service, but I'm probably not alone on that.

 

[DC]

Does a pay-to-use health-care system discourage use?

Oh yes, especially for people not having enough money to use that sytem.
also people having money problems will have to skip some checkups because of a lack of money, no mather if it later will cost more.

 

[Beth]

Oh yes, especially for people not having enough money to use that sytem.
also people having money problems will have to skip some checkups because of a lack of money, no mather if it later will cost more.

I agree. While for some people, like the OP, it doesn't affect their usage but for a great many people, it does. I've been through periods of being uninsured due to unemployment. My doctor visits were much more infrequent. I'd simply tolerate stuff rather than see a doctor and get medication. I certainly didn't bother with phsyicals which would run approx. $80 to $100 plus lab fees for any tests they wanted to run. That money was more appropriately spent on the mortgage (which got behind anyway), food, etc.

 

[Francesca R]

I can't help but think that if people had to pay for they wouldn't get routine check ups - potentially allowing for things like HIV to spread more efficiently.

Probably. Plus if vaccinations were billable extras then it seems highly plausible that herd immunity would fall with costs affecting those other than the individuals who wanted to save their cash.

I have to pay for oil changes on my car, but I get those oil changes regularly. Why? Because I have to pay even more if I don't.

I am no car expert but in the UK you risk criminal charges if you don't have a car certified once per year for stuff that probably includes oil. That's because you increase the risk to everyone else on the road if you cut corners and end up driving a dangerous vehicle. I don't know if you were referring to an additional legal incentive in your example, or just long run versus short run financial costs.

With one's health choices, it is much more intrusive for the state to be attempting to check whether you've looked after yourself in most cases, or to require that you do. But avoiding a disincentive to do that, when it is in the public interest as well as individual interest, makes very much sense.

 

[Undesired Walrus]

If you have little income, it's a no-brainer that you are going to avoid paying for certain vaccinations for yourself and your children. Humans take chances with health, they tend to only think short-term.

Which makes me curious: Are those in the states going to have to pay for the upcoming Swine Flu vaccinations?

 

[Dymanic]

Are those in the states going to have to pay for the upcoming Swine Flu vaccinations?

It's a Medicare covered benefit, so a lot of the high riskers will get it free. As for the rest, that may vary from State to State:

"Millions of Marylanders would be immunized against swine flu for free or for a nominal fee under a plan being developed by state health officials, whose goal is to provide the vaccine to every resident who wants it."
http://insidecharmcity.com/2009/08/18/free-swine-flu-vaccine-for-maryland-residents/

And if you're going to require some people to get vaccinated, it only seems fair that you'd pick up the cost:

"The New York State Department of Health has adopted an emergency rule requiring healthcare workers who have direct contact with patients to be vaccinated against seasonal and novel H1N1 influenza, the New York Times reported yesterday."
http://www.nytimes.com/2009/08/19/health/policy/19swine.html?_r=1

Of course, all of this is going to depend on there actually being vaccine available:

"Federal officials today during a pandemic H1N1 planning update dialed back the number of novel flu vaccine doses they expect in October from 120 million to 45 million, listing several reasons for the smaller projection."
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/aug1409vaccine.html

 

[Guybrush Threepwood]

I am no car expert but in the UK you risk criminal charges if you don't have a car certified once per year for stuff that probably includes oil.

Clearly not, the MOT does not cover oil changes.

I don't have statistics just the mighty power of the anecdote. It costs €60.00 to see a GP here, and it certainly makes me think twice about going.

 

[funk de fino]

I am no car expert but in the UK you risk criminal charges if you don't have a car certified once per year for stuff that probably includes oil. That's because you increase the risk to everyone else on the road if you cut corners and end up driving a dangerous vehicle.

The MOT does not include oil. It is a safety check and an emissions check for the car.

The reason it is a bad analogy however is that you can change your own oil.

 

[foxholeatheist]

I am been thinking about this for some time and I am pretty sure Americans would abuse the system.

Face it: Americans are whiny. They go to the hospital on the slightest excuse. Americans are hooked on their pills.

This is a little old but check this out:

Percent of persons using at least one prescription drug in the past month: 47% (2001-2004)

Most of the drugs have been for pain too. We just can't tolerate pain.
Source

In 2002, Americans filled 3,340,000,000 outpatient prescriptions.1 That's 12 prescriptions for every man, women, and child in America. Has the American dream become 2 kids, 2 cars, and a dozen drugs in each person's medicine chest?

Despite a cold economy in which most industries have seen sales drop, U.S. drug sales increased substantially in 2002, reaching $219 billion. According to NDCHealth, overall drug sales (all sources) grew 12% 2002, 18% in 2001, and 15% in 2000 (based on wholesale acquisition costs).

Source

I am fairly confident that Americans take more prescription drugs than any other country (I wouldn't be shocked if it was also twice as much as the runner up). Anyone have any hard data on this?

Again, I am just suspicious about Americans abusing (maybe "overusing" would be a better word) a freeish health care system. I am all for free life, limb, or, eyesight treatment but as for supportive and therapeutic care... I have not made up my mind.

The Army is a very socialized health care system (funny, the ultra right-wing guys here hate the Obama plan but have no problem using the more socialist Military health care system and love it) and my wife and I for the first time ever have the means to take care of health problems that we would ignore in the past. I'm a red blooded good old boy so I hate going to see the doctor unless I am in extreme pain but now I see the doctor regularly and the US Tax Payers are picking up the check. My wife goes in for her "feminine" needs which we just couldn't afford before. I also wouldn't go in for a simple illness, it had to be an incapacitating injury before I stepped foot in a hospital.

As a civilian I only saw the doctor if I broke a bone. I never went in for a simple check-up, they seemed something only rich yuppie folks did. So yes, in our little example we definitely do use a free health care system that was previously unavailable to us where, had we were required to pay for it, we definitely would not. That make any kind of sense?

I wonder how many other American's out there just pushing through whatever health problems they may have would come out of the woodwork to use the new system. Pure speculation but I imagine it would be quite a few.

 

[Darat]

...snip...

Most of the drugs have been for pain too. We just can't tolerate pain.
Source


...snip...

And why on earth should you tolerate pain?

 

[Ziggurat]

I am no car expert but in the UK you risk criminal charges if you don't have a car certified once per year for stuff that probably includes oil.

That's irrelevant to me, and hence has no impact on my motivation to get my car's oil changed, since I don't live in the UK. And as funk pointed out, it's not true anyways.

I don't know if you were referring to an additional legal incentive in your example, or just long run versus short run financial costs.

Just financial costs.

The reason it is a bad analogy however is that you can change your own oil.

Irrelevant since I don't change my own oil, I get it changed. My point, which has gone unaddressed, is that having to pay out of pocket for medical expenses creates more than one financial incentive regarding checkups (there's a disincentive because of the direct immediate cost, but an incentive due to possible larger future costs), these incentives operate in opposite directions, and it's not actually obvious which will win out overall. We can make guesses, but that's all they are.

 

[Francesca R]

My point, which has gone unaddressed, is that having to pay out of pocket for medical expenses creates more than one financial incentive regarding checkups (there's a disincentive because of the direct immediate cost, but an incentive due to possible larger future costs), these incentives operate in opposite directions, and it's not actually obvious which will win out overall. We can make guesses, but that's all they are.

The statement "we don't know" is rather unremarkable and not particularly inviting an "address".

When the public interest is served by everyone consuming the relevant healthcare service (such as vaccination), then it seems logical--assuming public interest matters enough--to remove the ambiguity in the incentives and lift the immediate cost. OK we don't know what everyone's "discount rate" of the monetary cost of future health (or the cost of future health service if that's what you mean). Well then better not guess.

 

[foxholeatheist]

And why on earth should you tolerate pain?

I am just saying that I don't think that pills are the answer. I find it hard to believe that some 40 odd percent of Americans require ongoing therapeutic care simply for pain. I could be wrong.