Posts Tagged ‘co-payment’

Financing public services in general and health services in particular has become a hot issue. At the end of May, I was a moderator at a simultaneous video conference held in the London School of Economics (UK) and the Hospital La Fuenfría (ES). The conference brought together professionals from the UK, Finland and Spain. The aim was to discuss new approaches to care services for old people.
During the questions and answers part, a lively discussion started on how to finance the cost of taking care of an increasing older population. We all know the statistics, so we don’t need to spend any more time on this issue. As is often the case on these occasions, two different camps arose: those who think that some kind of copayment has to be introduced, – for the sake of the discussion let´s say that this group was represented by Andy Stuart – and those who think that a social system that has been working till now should be kept, represented by me.
I am of the opinion that it will be very difficult to convince people who have been receiving a service till now without direct payment to start paying for it or, as I prefer to say, “repaying”, since they will be paying for the services through taxes and through direct payment. For the sake of discussion, I said that people prefer to pay more taxes than to pay for services. My reason for saying this was based on what I see: the only people that talk about how convenient it is to lower taxes are politicians. So far I have not seen in any of the popular movements and demonstrations across the Western word any banner asking for lower taxes, although I have seen a lot asking for better (more efficient) services.
I said it also in the spirit of making my counterparts react. Maybe they were too polite but the reaction was almost nil.
Nevertheless I must not have been so off the mark. A couple of recent studies have vindicated my point of view. The first one is by Matthew L. Maciejewski et al in Health Affairs. It concludes that copayment reduces the adherence to medication. The second piece comes from a survey carried out by the leading Spanish paper “El Pais”. The survey reveals that 85% of the population prefers to pay services through taxes. So, who is demanding lower taxes? Aren’t we getting involved in an ideological battle unrelated to the wishes of the population? Maybe we should listen to their call for BETTER AND MORE EFICIENT SERVICES. Let´s use public money for this purpose and avoid corruption and waste. Maybe we don’t need more money. Maybe what we need is a structural overhaul of the care system as we know it.

Read Full Post »