There’s a lot of talk about fixing the GP workload crisis by charging patients and using price to influence supply and demand. It seems to work for Dentists and reducing plastic carrier bag use but is it actually that simple or is reality a bit more complicated? Making a dramatic change like this could have huge unintended consequences and we need to be clear about what we are doing.
Collecting money does not do any patient care.
The overheads of setting up a collection system, issuing receipts, chasing payments and administering exemptions is all wasted. It is like forcing everyone to buy and install pay-as-you-poop toilets – no extra sewage is treated. We already have a system of funding primary care so the only excuse for the costs of an extra level of bureaucracy is to change patient behaviour.
Charging everyone is a fine on seeking help.
People will think twice about seeing a doctor – especially if they are poor. Introducing charges reduces use of health care by putting people off appropriate and inappropriate appointments and has worse outcomes for poor people (10% increase in mortality for poor hypertensives) (1). If the charge is to change behaviour and reduce unnecessary appointments, why are appropriate appointments penalised too? It is like fining everyone for speeding whether you are going too fast or not.
Charging makes patients feel like customers who can use what they like as long as they pay.
Health Care is something that we all need but we’re not sure when. Like roads, police, defence, sewage etc. it is more cost effective to club together to provide Health Care as a common good and it also frees us from the worry of getting sick and not being able to afford it. But like all common goods people need to use it responsibly. Unless the charges fully cover the entire cost of the service, it is cheaper to teach people how to use Health Care fairly and let social pressures do the rest.
Charging for treatment has not helped NHS dentistry.
“Following the government’s introduction of a new contract in April 2006, NHS dentistry is not as widely available as it once was, with 900,000 fewer patients seeing an NHS dentist in 2008 and 300,000 losing their NHS dentist in a single month” (2). The system of patient charges and the infamous clawback of funding has forced dentists switch to seeing patients privately to cover their costs. This has meant that as many as 1 in 10 patients cannot get an NHS dentist (2).
Unnecessary appointments may be contributing to GP workload but unmet need from the pandemic (3) and fallout from the crisis in A&E and hospital waiting times (4) seem much more of a problem. Charges to put patients off seeking care are unlikely to solve the problem and there is evidence they will cause harm.