Very interesting Tom. Most people accept the argument about the poor, the
old etc, being exempt and therefore reducing any benefit to a charging
scheme. I believe however that many of our inappropriate attenders (and I
still like that term, no matter what the politically correct, including GA,
try to tell me) are perfectly capable of paying. It doesn't particularly
upset my left-wing principles either, as it's not quite the same as private
medicine, there is in-built protection for those who cannot pay, and it's
not designed to generate revenue. We already accept prescription charges,
and dental charges, although I realise Bevan resigned over these!
I'm not convinced by the perceived "difficulty with collection" argument
either. It doesn't really matter if the exercise is cost-neutral; the idea
is to reduce demand on emergency services, not to generate income. Besides
there are now many innovative ways to administer payment; look at central
London congestion charging, for example; very high-tech and will deal with
several hundred thousand vehicles per day I expect. It's embarrassing how
high-tech everything outside the health service is! For example, the
National Lottery is an impressive feat of information technology, yet it
began back in 1994, and many other countries had theirs running years
before. This country may well move to smart cards anyway, containing
personal information etc. At last we might have accurate A&E registration
for once! And let's not forget the benefits to ambulance services as you
point out.
Finally I wonder does a charge affect the patient consultation itself. Are
patients more likely to be demanding, for example, of x-rays or
prescriptions etc? They already are, so a charge is hardly likely to make
this much worse...
Adrian Fogarty
----- Original Message -----
From: "Tom Hughes" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, December 11, 2002 4:05 AM
Subject: Re: emergency services demand
> the HK scheme has the fingerprints of Peter Cameron all over it,
> president of the Australasian College of Emergency Medicine who was head
> of the Royal Melbourne Hospital, and has been in HK sorting out their
> Emergency Medicine system for the past couple of years. (and trying to
> annexe HK to the Australian College ...... )
>
> As such, if the scheme works, it is likely to be replicated in Australia.
> I understand previous studies looking at this co-payment have found that
> after all the exclusions for being poor and or old (most of our
> inappropriate attenders), and there is a substantial overhead for
> collecting the charge. If collecting the charge could be outsourced, it
> might be feasable.
>
> A direct relevant parallel is that in Australia patients pay for
> ambulance transport (subject to the exclusions above/ you can buy
> insurance) and there is much less use of them as taxis.
>
> tom
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