Elpais.com article published in the May 10, 2011 Jaume Puig-
Junoy and Marisol Rodríguez Martínez
While almost no one questions our pharmacy copayment, although that requires urgent reform, there is a priori rejection to assess the appropriateness Other co-payments introduced in the health system.
Nine of the 15 countries of the EU-15 are co-payments for all types of services: doctor visits, hospitalizations, pharmacy, dental and other services such as emergency, diagnostic tests, medical transportation, prosthetics, etc. Of these nine countries, seven have a health system that responds to the Social Security model (model Bismark) and two Nordic countries (Finland and Sweden) with the national health system Beveridge. Social security systems usually have a higher coverage level, as stipulated and defined explicitly, with great level of choice and many co-payments.
in national health systems in Northern Europe the coverage is often also large, but also pay more taxes and there are many co-payments, although limited in amount and usually linked to income level. In no country is equated with free universal access absolute time to use the services.
is well known that when something is fully insured, individuals tend to show less care to conserve and care. Moreover, as we have already paid "and it cost us zero in the time of consumption, we tend to over-consumption. The objective of copayments is threefold: moderate consumption, co-responsible citizens, to get the services not to consume less valuable than those not to affect health and, sometimes, serve as additional source of funding health. Misapplied, however, have problems.
If there are no limits or maxima, can be a "tax" on the sickest. If not linked to income level (which may achieve exemption), the burden of co-payment ends up being much greater in terms relative in the case of the poor than for the rich. If you set uniformly regardless of the effectiveness of the service or treatment, the patient left the difficult decision to discriminate between the more valuable and less valuable.
If affecting only one type of goods or level of care, you run the risk of deviations from consumption to those goods or level was not affected and the cost ends up being higher. Finally, failure to protect the poor and the sick, may be a compensation effect and eventually generate more spending than is saved by the deteriorating health of the most seriously ill. Therefore, the debate on the copayment should not be raised as a extreme choice between yes and no.
In Spain, the design of the copayment on drugs is too simple and has not changed since 1978 and applies only to active workers, who pay 40% of the cost of the recipe, with the exception of certain drugs for chronic treatments in which the copayment is 10% with a cap of 2.64 euros. During this time we have observed that encourages overconsumption. The change of status of non-pensioner pensioner an increase in the number of recipes that otherwise would not have occurred (moral hazard): the consumption per person increased about 25% in the first year free. The financial impact for the public (free over moral hazard) may increase spending by more than 100%.
is also inequitable. To be independent of the economic, a pensioner who charge a higher pension or has an estate millionaire pays nothing, while an unemployed person or a family with young children mileurista, pays.
Ultimately, we would recommend: 1) modify the design of pharmaceutical co-payment, eliminating the arbitrary distinction between active and retired, and include outpatient hospital drug dispensing, 2) introducing a fixed co-pay visits, and in emergencies, 3 ) to introduce fees covered ancillary services and public prices for services not currently covered, 4) modular co-payments based on clinical and cost-effectiveness with copayments avoided whenever possible, and 5) implement mechanisms to protect the economically weaker and more ill. This could include setting a maximum contribution limit per quarter or year depending on family income, with total exemption from the lowest income, whether from work or pension, and special treatment for illness chronic or multiple conditions. Co-payments and other forms of contribution should not be impoverished by what the limit should be a small percentage of family income.
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