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And it can keep getting worse: Is the extra fee to be designated as tax collection, when presumably it is compulsory and goes back to the government? Or is it designated as co-payment by the patient to the professional i.e. a direct fee for service provided? In Ontario the Conservative government recently introduced a $2 copayment fro every drug prescription item filled. Result : pharmacists particularly in competitive areas and those with many poorer or senior clients are forgiving the charge and essentially taking a fee reduction. If the same thing happens in general practice you can envisage the increased volume of recalls you describe happening. Bob Frankford >> > On Thu 19 Sep, Ahmad Risk wrote: >> > >> > > As for collection at the Surgery, a swipe card linked to the >> > > paymasters will do just fine! No cash, no admin, no crime, >> > > no fuss! >> > >> > Trims replied: Okay, so let's think this through. >> > >> > Who devises, designs, implements, and pays for the swipe card >> > system? >> > >> > If benefits recipients just have to present their card (as in >> > Australia) where's the disincentive? >> >> What happens in any card based system when the patient is truly sick, >> unconscious, demented, unable to obtain a card, had their house just >> burned down etc, etc? It's a serious problem, which we have here >> in Ontario. The bureaucrats who plan health systems assume that >> everyone is just like them, planning appointment well in advance >> and presenting their cards as they arrive well in advance for their >> appointment. >> >> If only life was so easy > >But it gets worse. What about the effect it would have on clinical >behaviour? There may be significant incentive to drag back those >hypertensives for their "essential" monthly review. An extra 1000 >consultations per year x 5 pounds = quite a lot of money. > >Presumably the co-payment would be considered part of net intended >remuneration? Could we anticipate a rising consultation rate and >static income - precisely what we're trying to avoid? > >Our Aussie colleagues may correct me, but I believe this is how it >feels in their fee for service system. > > >Trims. > >-- >Dr Ian Trimble email: [log in to unmask] >Sherwood Health Centre >Elmswood Gardens Tel: +44 115 962 4516 >Nottingham NG5 4AD Fax: +44 115 985 7899 > > > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%