Like I said, why charge the user fee just for the first visit? I think it was my Mum that told me that hospitals in BC used to charge a couple bucks a day for every day one spent in the hospital, not just the first day. I bet even the homeless could scrape up a $20 for one single visit.
HEALTH CARE - User fees
- Thread starter JLM
- Start date
I disagree with the opening premise that our health care system is in disarray. I've had heart surgery in this country. My kids and grand kids have had quite a few broken bones and other minor problems over the years and the system took good care of all of us. We had no unreasonable wait times. I know there are some long waiting times for joint replacement surgery and some other procedures but it is getting better. Our system with it's warts is still one of the best around.
Well, there has been entirely too much sweetness and light here, with most agreeing how good an idea of user fee is, singing praises of user fee. I think it is about time I set the cat among the pigeons.
User fee is a terrible idea. Who is it going to discourage from visiting the doctor? It will be low income people of course. If that single mother has to pay 20 dollars every time she visits doctor, she may decide to ignore that fever, ignore that pain in the chest, hoping that it will go away.
Now, most of the times it probably will go away. However, in a few cases it will lead to complications, necessitating a hospital visit.
Let us say, 20 patients do not see the doctor because of the 20 dollar user fee. Out of that, 10% develop complications, and have to be hospitalized for one day each. That will mean hospital costs well in excess of 1000 $ each, it will cost more than 2000 $.
As opposed to that, suppose there was no user fee and all 20 had visited the doctor. The average fee the doctor gets for a patient visit is around 35 $, so the cost would come to 700 $.
700 $ as opposed to 2000 $, so what have you saved?
User fee is a terrible idea. Who is it going to discourage from visiting the doctor? It will be low income people of course. If that single mother has to pay 20 dollars every time she visits doctor, she may decide to ignore that fever, ignore that pain in the chest, hoping that it will go away.
Now, most of the times it probably will go away. However, in a few cases it will lead to complications, necessitating a hospital visit.
Let us say, 20 patients do not see the doctor because of the 20 dollar user fee. Out of that, 10% develop complications, and have to be hospitalized for one day each. That will mean hospital costs well in excess of 1000 $ each, it will cost more than 2000 $.
As opposed to that, suppose there was no user fee and all 20 had visited the doctor. The average fee the doctor gets for a patient visit is around 35 $, so the cost would come to 700 $.
700 $ as opposed to 2000 $, so what have you saved?
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Another problem will be with preventive care. Again, look at that poor family or single mother working a minimum wage job. There is no necessity to go for Pap smear, for breast examination etc. She is not experiencing any pain or anything. Then why blow 20 $ for something that may not be necessary (and which she can ill afford)?
Same will apply for well baby check. The baby appears to be all right, well behaved, why pay 20 $ for post natal care? That 20 $ could be better used for baby’s formula or diapers. Or why go for cancer check up (colorectal cancer etc.) when you have to pay 20 $ for it?
So preventive care will become practically nonexistent, especially among the poor, but perhaps in middle classes as well, Why pay 20 $ when you don’t have any symptoms, when you are not ill?
The result will be an increase in cancer incidence, an increase in children’s illnesses (due to lack of post natal care), which will mean huge extra expenditure for the health care system. The user fee will be totally counterproductive.
Same will apply for well baby check. The baby appears to be all right, well behaved, why pay 20 $ for post natal care? That 20 $ could be better used for baby’s formula or diapers. Or why go for cancer check up (colorectal cancer etc.) when you have to pay 20 $ for it?
So preventive care will become practically nonexistent, especially among the poor, but perhaps in middle classes as well, Why pay 20 $ when you don’t have any symptoms, when you are not ill?
The result will be an increase in cancer incidence, an increase in children’s illnesses (due to lack of post natal care), which will mean huge extra expenditure for the health care system. The user fee will be totally counterproductive.
Third problem would be what happens if somebody refuses to pay? A patient shows up at doctor’s office in need of medical treatment, but refuses to pay. And some will refuse to pay, a few out of sheer cussedness, others because they really don’t have the money.
If somebody comes to doctor’s office with a sob story as to how they cannot afford to pay, what is the doctor going to do? Turn the patient away? Many doctors will have ethical problem with that. Plus, the College of Physicians and Surgeons guideline will probably say that a doctor cannot refuse to treat a patient if he/she cannot pay the 20 $ visit fee.
Then is the doctor out of pocket? I assume the way it will work is if patient has to pay 20$, the government will pay the doctor 20 $ per patient less. Then the doctor is on the hook for anybody who doesn’t pay. Say a doctor sees 30 patients a day, 5 of them refuse to pay. That means the doctor is on the hook for 500 dollars per week.
Who is going to make up for that? If doctor has to take a cut in income, that means government has picked a fight with doctors. No government can win a fight with doctors, as Mike Harris found out here in Ontario to his cost.
So collection of the fee will also be a problem. The user fee here is not like paying for a pen or a loaf of bread. If you go to the store and you don’t have money, you don’t buy the loaf of bread or the pen, period. The store keeper is not going to give it to you just because you have a sob story (and no money). But a doctor’s office works totally differently.
If somebody comes to doctor’s office with a sob story as to how they cannot afford to pay, what is the doctor going to do? Turn the patient away? Many doctors will have ethical problem with that. Plus, the College of Physicians and Surgeons guideline will probably say that a doctor cannot refuse to treat a patient if he/she cannot pay the 20 $ visit fee.
Then is the doctor out of pocket? I assume the way it will work is if patient has to pay 20$, the government will pay the doctor 20 $ per patient less. Then the doctor is on the hook for anybody who doesn’t pay. Say a doctor sees 30 patients a day, 5 of them refuse to pay. That means the doctor is on the hook for 500 dollars per week.
Who is going to make up for that? If doctor has to take a cut in income, that means government has picked a fight with doctors. No government can win a fight with doctors, as Mike Harris found out here in Ontario to his cost.
So collection of the fee will also be a problem. The user fee here is not like paying for a pen or a loaf of bread. If you go to the store and you don’t have money, you don’t buy the loaf of bread or the pen, period. The store keeper is not going to give it to you just because you have a sob story (and no money). But a doctor’s office works totally differently.
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User fee can work only if we are totally ruthless about it. Suppose a patient goes to doctor’s office. He is obviously sick, running a high fever. He cannot pay. Then the doctor must turn him away, no matter what the outcome. Only that will serve as lesson for the people that they must pay the user fee.
Or say a patent goes to hospital emergency with some sickness. During the examination, it transpires that the patient has been neglecting the illness, he did not go to the doctor to get treated for it (to save on the user fee). Then the hospital must turn the patient away without treatment, since the patient was trying to save money and in the process, ended up costing the health service much more.
Once a few cases like this are made public (some of them resulting in death), then people may start taking the user fee seriously.
But no civilized country is going to be ruthless like that, least of all Canada. So user fee is a non starter.
Or say a patent goes to hospital emergency with some sickness. During the examination, it transpires that the patient has been neglecting the illness, he did not go to the doctor to get treated for it (to save on the user fee). Then the hospital must turn the patient away without treatment, since the patient was trying to save money and in the process, ended up costing the health service much more.
Once a few cases like this are made public (some of them resulting in death), then people may start taking the user fee seriously.
But no civilized country is going to be ruthless like that, least of all Canada. So user fee is a non starter.
User fees were tried in Alberta and were a complete failure for several reasons. First of all some people simply refused to pay them. Attempts by the Alberta government to collect eventually proved more expensive than what the fees took in. Second, the fees discouraged people with minor ailments from seeking medical attention until they had major ailments, thus greatly increasing the eventual cost of treatment. In some cases people stopped having their yearly physicals making it impossible to diagnose and treat minor ailments early.
User fees are a simplistic approach to medicare costs. If you really want lower health care costs put more money into health clinics and preventive medicine. If you want much lower health care costs get rid of all the profit-making private sector connections and if you want drastic reductions in health care put all doctors on salary.
User fees are a simplistic approach to medicare costs. If you really want lower health care costs put more money into health clinics and preventive medicine. If you want much lower health care costs get rid of all the profit-making private sector connections and if you want drastic reductions in health care put all doctors on salary.
Quite so, Bar. I did not know of Alberta's experiment. But what I said will happen in my posts, exactly the same things seem to have happened in Alberta.
User fee appeals to those (mostly conservatives) who like to propose simple solutions to very complex problems (economy is in a mess? Cut taxes, health care has got problem? Start user fee).
There are other , innovative ways to cut costs. And interesting that you should mention salaries. In Ontario, that is the preferred model these days, government is encouraging doctors to go on salary. More and more doctors are going on salary. My wife is considering it and may do so in a few months.
Why make a problem where there is none- they have the guys mailing address and you mail the bill, if he doesn't pay within the allotted time, it just goes to collections. YOu can't beat collections or I should say it's not worth hassel even trying.
You have to give people credit for having some brains, people know when they are sick, some people just want to have their hand held or need someone to talk to.
So doctor has to chase after the patients for money? I am sure the doctors are just going to love that. Rather than practice medicine, they have to become a collection agency.
Anyway, do you know how much you get if you give it to a collection agency? You may be lucky if you get 50 cents on the dollar (the collection agency keeps the rest).
If doctors have to be responsible for collecting the user fee, you will have a rebellion on hand. As I said before, you don’t want to pick a fight with the doctors, you would be certain to lose.
"First of all some people simply refused to pay them."
What percentage of people refused to pay them? I'm guessing between one and three percent. That would be a temporary situation. AFter awhile when things improve and health costs go down and service improves most people will willingly pay them.
What percentage of people refused to pay them? I'm guessing between one and three percent. That would be a temporary situation. AFter awhile when things improve and health costs go down and service improves most people will willingly pay them.
People don’t know when their illness will get well by itself and when it will lead to complications JLM. For that matter neither does doctor. So it is important to treat all the illnesses in the initial stages so that there are no complications later on requiring hospitalization (and huge costs associated with it).
There was an interesting article about that very thing in Readers' Digest several years ago- about 99% of illnesses take care of themselves and of the few that don't a doctor can't do much for the majority of them.
I guess that you live in the province of plenty. I was of the opinion that medical expenses were tax deductable in all provinces. I can deduct medical expenses that are in excess of 3% of my earned income. Medical expenses include, health care premiums (when we paid them), extra health care like blue cross, dental expense, travel to doctors offices, eyeglasses and examinations, meals while traveling. I am glad that I live in Alberta as we are allowed to deduct these expenses. Look under the Medical Expenses in your income tax program and if in doubt seek advice with the help key.
I have to take meds daily for thyroid. I get 90 days worth at a time. I also get another prescription that is given to me in 3 month intervals but it comes with refills so that it coincides with the thyroid meds. and so that I only have to go in every 3 months. My doctor sends me for thyroid testing almost everytime I go in. Actually, he gives me a requisistion that I continue to forget to have the blood work done and continue to promise to have it to him "the next time". I guess I should go get that done next week.
As for eyes - here in town, most eye glass stores, now have a sign outside that says "Free sight testing". I went to the optometrist as I know they are more thorough. I know that I am in the beginning stages of cataracts and that in a few years they will need to be checked again. I doubt the free sight testing would have provided me with that information. Hubby's plan repays us for the cost of the eye exam. Between his plan and mine, I will be repaid $350.00 of the $550.00 (or there abouts) that I paid just for my glasses alone. I was lucky too on dental. Between our two plans, I had over $3,000.00 worth of work done and I paid $142.00 myself. I feel pretty lucky.
No - Taxslave is quite correct. We still pay premiums and they are not now nor have they ever been tax deductible. Eye glasses were never included either and examinations such as he is talking about come out of your own pocket. Doctors here post a list of the costs for these things.
We in Ontario can also deduct them (in excess of 3% of the income), but unless you are really sick and have large medical bills, you get nothing. In all these years that I have been filing tax return, I was able to get tax deduction only once, and that was less than 100 dollars.