Article published in ELPAIS.com, 07/02/2011
http://www.elpais.com/articulo/sociedad/Poner/orden/hacer/caja/elpepusoc/20110207elpepusoc_7/Tes
The health deficit CCAA is the result of revenue shortfalls and expenditure growth accelerated not the level of spending per person. Use financial responsibility instruments such as fees, prices or copayments can serve two different purposes that requires explanation. May serve to increase revenue (to cash) and also help the use of more effective services and to reduce the misuse (to order). It is likely that if applied with caution (regarding income and effectively) and income / savings reinvested in public health are much more acceptable to citizens who think some politicians.
Whatever the objective, we must take two things very clear: the first is that co-payments alone are not "the" solution to anything but just a tool to be used in coordination with other measures of health policy. The second is that no one should speak of "copayment" but copayment / rates / public prices in the plural: They can go from being a brute "sick tax" to tune instruments that encourage physicians and patients choose the most effective treatments and lower cost, and exemptions and ceilings as the economic capacity of patients.
If co-payments are applied to help bring order (more selective application), provided in conjunction with other concurrent and coordinated, the best co-payment system would be one that raises little because only applies unnecessary and achieves its goal freeing resources . Here the prescription is clear: not only the cost of management must be as low as possible but that the identification of inappropriate use should be made with scientific and clinical criteria. The result will not be measured both by euro obtained as the reduction of unnecessary use.
Where to begin if the goal is to bring order? Start where inadequate identification is clear and easy to manage is the best guide. The selective application of copayments on medical emergencies is complex but feasible, provided it is applied also to other services and that the source of the inadequacy is not the lack of adequate response in primary care.
For primary care visits a low-intensity rate can help reduce unnecessary pressure by minor symptoms. Be careful to avoid cross-effects (more emergency pressure) and prevent chronic medical visits should more often end up with expensive offs. Rehabilitation services, can be used to penalize defaulters, etc..
drug case is more clear, urgent and easier to manage: unfair and inefficient redistributing the current pharmaceutical copayment copayments to avoidable (not paying more for the same and if the patient wishes to pay the price difference), and differential (the more necessary and cost-effective, lower co-payment), and a low copay intensity that would exempt only the truly poor.
not for economists but the clinical and scientific evidence indicate inappropriate use, but to propose sensible applications in each case: copayments avoidable preferable to traditional co-payments (fixed or variable amount according to cost or price), low copayments versus high intensity, deductibles, essential boundary cumulative maximum contribution per person related or unrelated to income, exemption criteria and forms for low income and children, avoidable contribution as the price difference between equivalent co-payment based effectiveness and cost-effectiveness of treatment, design of tax relief income tax, etc.. Are these details and not the fact itself that the patient pay some of which establish the goodness or badness of the system.
If copayments are designed with the objective of making housing (more extensive implementation), legal and political option preferable to the current scenario of plummeting government revenues take financial measures to impose more blind and hasty, economists can give indications to mitigate the distributional impact and impact on health. Is a recurrent error to think that one euro more in tax revenue is always more progressive than the euro itself obtained through a public price, rate or copayment.
Both the recent increase in the VAT and the so-called "health penny" in the tax Hydrocarbons are clearly regressive and, instead, it is possible to design a co-payment is not (at least, to not be so.) Copayment limits are recommended accumulated (maximum amount or percentage of income) and derogations to lower income individuals and children.
non-clinical services provided by public health are a good scope (hospital catering, for example). I leave aside the new services that may be included in public coverage and now pay part or not provided (extending dental coverage, podiatry, ophthalmology, etc.) With a rate lower than cost, what is done is to increase grant and reduce the price that we paid out. This is not to only reduce copayments.
0 comments:
Post a Comment