Supplementary physicians’ fees: a sustainable system?

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.

Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran

“…One of the additional measures could be an introduction of copayments or of "supplementary fees" on top of the official tariffs set by the health insurance system (e.g. alike those in Belgium and France) [45]. Improvements in the health workforce system and its supply should also be considered.…”

A model for dual health care market with congestion differentiation

“…In concrete terms, it is easiest to think of quality as the time a physician spends with a patient to conduct a procedure". This de…nition -which re ‡ects the healthcare situation in France -does not suggest a di¤erence in quality of medical care provided per se, rather substantial di¤erences in the non-medical dimensions of the service and patient-perceived quality of care (Calcoen and van de Ven, 2019). In particular, it has been shown that sector 2 specialists perform longer consultations (+4% in per-patient consultation time) than their sector 1 counterparts, all other things being equal (DREES, 2006).…”

“…Why then would anyone pay an out‐of‐pocket fee for a consultation in sector 2, when consulting a specialist in sector 1 is effectively free (except for the 1 euro copayment)? The differentiating factor is the quality of the service provided, defined broadly by Glazer and McGuire (1993) as: “any costly nonprice attribute of health care that affects patients' valuation, including dimensions of convenience, comfort, communication about medical conditions, and other factors… In concrete terms, it is easiest to think of quality as the time a physician spends with a patient to conduct a procedure.” This definition—which reflects the health care situation in France—does not suggest a difference in the quality of medical care provided per se, rather substantial differences in the nonmedical dimensions of the service (amenities) and patient‐perceived quality of care (Calcoen & Van de Ven, 2019). In particular, it has been shown that, all other things being equal, sector 2 specialists perform longer consultations than their sector 1 counterparts; the spread can be as high as 5 min (15%) in psychiatry and cardiology (DREES, 2006; Guyon, 2009).…”

Service quality attributes on customers’ perceived value and behavioral intention of district health centres: a moderating effect of health-care subsidy

“…Lastly, although the government offers health-care subsidies to local citizens, no evidence has been presented on whether service fees provide a better quality of care to patients (Calcoen and Van de Ven, 2019). The relationship between health-care quality and price and payment of health-care procedures was under investigation (Chen and Miraldo, 2022).…”