Supplementary physicians' fees: a sustainable system?
Piet Calcoen1, Wynand P M M van de Ven1
1Department of Health Policy and Management,Erasmus University Rotterdam,The Netherlands.
Insights
Supplementary physician fees in Belgium and France are unsustainable due to financial concerns and lack of clear patient value. Despite rising costs, evidence does not support better quality of care for these extra payments.
Area of Science:
- Health Economics
- Healthcare Policy
Background:
- Physicians in Belgium and France can charge supplementary fees beyond basic health insurance.
- These supplementary fees are increasingly unsustainable, with expenditure rising faster than total health costs.
Purpose of the Study:
- To analyze the financial sustainability and patient value of supplementary physician fees in Belgium and France.
- To evaluate the impact of supplementary fees on healthcare access and perceived quality of care.
Main Methods:
- Analysis of expenditure trends for supplementary fees versus total health expenditure.
- Review of factors influencing patient willingness to pay supplementary fees, including perceived quality of care.
Main Results:
- Supplementary fees constitute a significant portion of income for some physicians (up to one-third).
- The added value for patients is unclear, though fees may influence comfort and access.
- No evidence currently links supplementary fees to objectively better quality of care.
Conclusions:
- The current system of supplementary physician fees is financially unsustainable.
- Linking fees to quality of care raises social acceptability concerns.
- Policy measures to curb the trend in supplementary fees have been unsuccessful.
Abstract:
In Belgium and France, physicians can charge a supplementary fee on top of the tariff set by the mandatory basic health insurance scheme. In both countries, the supplementary fee system is under pressure because of financial sustainability concerns and a lack of added value for the patient. Expenditure on supplementary fees is increasing much faster than total health expenditure. So far, measures taken to curb this trend have not been successful. For certain categories of physicians, supplementary fees represent one-third of total income. For patients, however, the added value of supplementary fees is not that clear. Supplementary fees can buy comfort and access to physicians who refuse to treat patients who are not willing to pay supplementary fees. Perceived quality of care plays an important role in patients' willingness to pay supplementary fees. Today, there is no evidence that physicians who charge supplementary fees provide better quality of care than physicians who do not. However, linking supplementary fees to objectively proven quality of care and limiting access to top quality care to patients able and willing to pay supplementary fees might not be socially acceptable in many countries. Our conclusion is that supplementary physicians' fees are not sustainable.
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