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Open Access 01-12-2019 | Care | Original Research

Co-payment for Unfunded Additional Care in Publicly Funded Healthcare Systems: Ethical Issues

Authors: Joakim Färdow, Linus Broström, Mats Johansson

Published in: Journal of Bioethical Inquiry | Issue 4/2019

Abstract

The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment—a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from worries that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed.

Other terminologies have been used to refer to this model (Mossialos et al. 2015). While some writers use the term “cost sharing” (Barnieh et al. 2014) others refer to “excess charges”, “additional services”, and “top-ups” (Richards 2008).

In group-based systems certain population groups are eligible for publicly funded care; in sectorial systems some healthcare sectors are publicly financed. Different versions of these models have been incorporated in healthcare systems in different countries (Tuohy et al. 2004).

In October 2015 a senior consultant at the department of lung diseases in Haukeland University Hospital, Norway, applied to the local board of ethics (Notat fra Klinisk etikk-komité, Helse Bergen 2015) to use a co-payment solution involving Nivolumab (Opdivo), a drug that is given intravenously for the treatment of advanced cancers. The consultant had found that some patients with lung cancer were willing to pay the extra cost for Nivolumab if the drug could be administered at the hospital in conjunction with planned visits and other funded healthcare measures relating to the monitoring of the disease. At the time in Norway, Nivolumab was not a publicly funded form of treatment for lung cancer, although the evidence suggested that it promoted an extra median survival period of three months for patients with this diagnosis.

It has been pointed out that the “position of charging for treatments that have not been deemed as cost effective” might be regarded as perverse (Richards 2008). Such an impression, however, relies on a misunderstanding, since almost any positive effect may seem worthwhile at the individual level. Under no circumstances should we apply societal principles of prioritization, which are constructed in order to prioritize between groups, at the individual level.

In the aforementioned evaluation of a potential co-payment solution involving the drug Nivolumab the local board of ethics in Bergen, Norway, (Notat fra Klinisk etikk-komité, Helse Bergen 2015) referred to a principle of equity in healthcare that should not be violated. On the boards’ interpretation of it, the principle means that equals should be treated equally.

Matching intentions can be tracked to international statements about Universal Health Coverage (UHC). UHC is defined by WHO and the World Bank as follows: “all people receive the health services they need without suffering financial hardship when paying for them” (Lancet 2016; Norheim 2015; Chalkidou et al. 2016).

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Title: Co-payment for Unfunded Additional Care in Publicly Funded Healthcare Systems: Ethical Issues
Authors: Joakim Färdow
Linus Broström
Mats Johansson
Publication date: 01-12-2019
Publisher: Springer Singapore
Keyword: Care
Published in: Journal of Bioethical Inquiry / Issue 4/2019
Print ISSN: 1176-7529
Electronic ISSN: 1872-4353
DOI: https://doi.org/10.1007/s11673-019-09924-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Co-payment for Unfunded Additional Care in Publicly Funded Healthcare Systems: Ethical Issues

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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