Co-payment for Unfunded Additional Care in Publicly Funded Healthcare Systems: Ethical Issues

Abstract

The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment-a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from worries that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed.

An Egalitarian Perspective on Information Sharing: The Example of Health Care Priorities

“…This may, potentially, be something that individual patients would benefit from knowing about, and hence in this sense the information about them can be actionable. Patients can, for instance, turn to private health care providers, whether those providers coexist within the publicly funded system or work through co-payment solutions [ 16 ]. Informing patients about such possibilities is mirrored in GMC guidelines, where it is clarified that other information that can be relevant includes “any treatments that you believe have greater potential benefit for the patient than those you or your organization can offer” [ 17 ].…”

The problematic place of private payment for healthcare in Australia

“…People typically feel good about being able to choose and, conversely, feel frustrated when they are being barred from a choice between alternatives that could have been offered to them. 14 The marketing of substitute insurance might emphasize a choice of better amenity or faster access to care, bypassing public-sector priority setting. 15 Private payment for improved amenity-a bigger room or better food-does not impinge fundamentally on equity.…”

Responsibility for Funding Refractive Correction in Publicly Funded Health Care Systems: An Ethical Analysis

“…In these conditions, customers have genuine freedom of choice across a wide range of, as it were, selling points (many of which are not directly related to refractive correction). It is by no means obvious that this freedom is transferable to the public sector—at least, in the absence of a hybrid model where patients are allowed to part-fund products that are not available within the public sector [ 9 ]. Now, nothing rules out a parallel, private system like the one we have today.…”

“…Spectacles were removed from the public health system at that point mainly for fiscal reasons. 9 This straightforward argument hardly convinces anyone-at least, not without linking it to an assessment of public need and the alternatives. If the mere fact that something is expensive were a satisfactory argument, we could shut down the publicly funded health care system altogether.…”