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Tuesday, 29 August, 2000, 09:05 GMT 10:05 UK
Doctors appointments: Should people pay?
A new survey suggests many doctors in England are in favour of charging patients £10 for appointments.
They believe this will cut the number of times when a patient arranges to see his or her GP and then does not bother to turn up.
But will this deter people who are less well off from attending their doctor, even if they are ill? Or are doctors who favour the change right to demand an end to time wasting in surgeries?
"Co-payments" of $5 - $15 USD are the rule in the US. While 10 pounds sounds a bit steep ($16.50 USD), the system works well to keep down the overall cost of health insurance (a sore spot to many private industries), and also reduces unneeded visits to doctors for trivial problems. It's an all around win-win solutions.
May I suggest a more reasonable amount of £5-8?
Surely it is only right that those who abuse the system and fail to keep their appointments should be penalised, not those who are in genuine need.
Why should we have to pay to see a Doctor? We pay National Insurance and surely that is what the NHS is for? The fact that they are incapable of making sure the money goes to the right places is not something that "Joe Public" should be penalised for.
This is a great idea. Having worked in Belgium for a few months and needed to visit the Doctor on a number of occasions, I found it was much better to pay a fee direct to the doctor. I walked in during opening times and was guaranteed to see the doctor every time. I think the fee reduces the amount of time wasters in the waiting rooms and the Doctors perform their job with a little more care. It gets very annoying here when you almost feel you need to plan in an illness to ensure that I can get an appointment when I really need it.
Mark Lisle, Germany (UK citizen)
I would be happy to pay £10 if I were getting the appointment on the day I want, the time it suits me with the doctor I know. But not if this pushed the free visits away, creating endless queues (like NHS hospitals). We already pay National Insurance and taxes. Doctor's service is included in this price, is subsidised by all tax payers for the benefit of all
How about I charge the doctor for loss of earnings for the appointments he doesn't keep with me? Every time I book a doctor's appointment, I am never seen any less than ten minutes later than the time I booked in for. When I was a temporary worker, this had a real impact on my earnings.
If the doctor can charge for a missed appointment, then I should be compensated for having to sit through my appointment time!
Mike Brownstein, NYC, USA
I am self-employed. A visit to the doctor already costs me dearly in lost earnings, so why should I pay more?
Last year I was residing in Dublin where you pay to visit your GP as a matter of course, even though all employees have private medical insurance.
Charge patients that don't show up for appointments. It may teach people to be more responsible the hard way, and will definitely bring some much-needed cash into the NHS.
P. Hewitt, UK
I've been living in Argentina for five years and we have to pay a percentage of our wages to a "sort of" national health service. But we have to queue up at the health office for maybe an hour, pay $3 for a certificate which then authorises us to see the doctor. However, if one is paying a contribution to the national health service, then nobody should have to pay. If doctors are angry at people not turning up for their appointments, why not introduce a fine for "no shows". Fees will only prevent the not so well off from going to see their doctor when they are REALLY ill.
I have to visit my doctor every 12 weeks for an implant to combat prostate cancer. Should I have to pay £40.00 a year? I don't think so!
Only £10? Don't knock it!
I have to pay $50 just to get in to see my doctor!
So long as I can claim each £10 back from my National Insurance I can't see a problem.
Phillip J Hubbell, USA
While I'm sympathetic to overworked doctors, I can't help think that if this charge was introduced then at some point, somebody who really does need help is going to be put off going to their GP.
It might sound over-dramatic, but someone, somewhere is going to die for the sake of £10.
Now charging people who don't turn up for appointments, that's another matter entirely!
I already pay NI and Tax to pay for health services so why should we pay £10 on seeing the doctor? I can afford to pay but those who can't will just not go. It will lead to more home diagnosis and worse health for the poorer people in society. It will be like going back to Victorian times.
What, pay yet again for something I have already paid for time and time again? You must be joking. I already pay for it in so-called National Insurance. According to Tony Blair I am also paying for it in extortionate gasoline duty! What about VAT at 17.5%? Council tax? Road fund licence? Duty on beer and wine etc.... need I go on? As far as I am concerned you can whistle for it. Got the telephone number of the nearest U.S Embassy?
Matt A, UK
Why should I have to pay £10 every time I want to see my doctor? I pay a large fee of my wages in National Insurance already. Can't there be some kind of penalty for time wasters, without penalising those who really need medical advice?
It is stupid. The NHS is supposed to be free, yet with prescription charges going up all the time and now this, I might as well go private.
Les Moody, UK
Keep the NHS free. After emigrating to a country where you pay for all your health care, you realise just how much it does cost, especially when you have a family
It always makes me laugh that you British put up with so much. You already pay NI which is supposed to pay for this and now your own government proposes to make you pay again!!!
There has always been a group of doctors who wanted to destroy the NHS as a service, free at the point of use. The problem now is the lack of doctors - often directly due to the fact that it is horrendously expensive to get training and very lucrative to then supply your services to the private sector who haven't had to pay anything for that training!
People who want to eliminate time-wasters should look at other ways. Remember that prescription charges were introduced at a minimal rate and now cost far more than many of the drugs prescribed. We need no more attacks on our 'free' health service!
Dr. Grammer, Wales
Oh I get such satisfaction seeing the ££'s removed from my wages each month going towards my NI contributions!
I believe that £10 is a good idea. It will make people wake up to their responsibilities instead of always saying that it is not their fault that they couldn't make it.
Also, I believe that there should be a refundable £10 deposit for equipment given to patients. Equipment such as crutches, neck braces, muscle protection etc. You will be amazed how much of this equipment is NEVER returned to the hospital that issued it.
I have read many of the comments with interest. Those who wish to criticise GPs' performances should remember that the countries that they choose to make comparisons with, such as France or Germany, have considerably more doctors per head of population than are available in the UK. GPs and hospital doctors are very overburdened, and at some point this has to have an effect on standards. We have seen nurses become demoralised and leave the NHS in droves. The same will happen with doctors in the near future if conditions are not improved. If charging £10 will make people stop and think before seeing their GP, then all well and good. It's about time the public and politicians woke up and realised that there is no such thing as a free lunch. At some point quality healthcare has to be paid for.
I worked in a pharmacy until last week, and many of our patients are covered under the state health plan. They often receive health care the average working citizen could not afford. We filled a prescription for a woman who said she wasn't taking the medicine anymore. But she was perfectly willing to take the prescription (for free, of course), and then throw it away. Paying a nominal fee might actually encourage responsibility in some people who otherwise abuse the healthcare services.
I went to the doctors in the UK last week. Surgery was packed, hadn't seen a lick of paint for 20 years, I didn't see the doctor until over an hour after my appointment time and got given the usual antibiotics. Here in Germany I walk into the doctors, get seen immediately without an appointment, the waiting room isn't packed out with people and I have never been given antibiotics. But you get what you pay for. In Germany people pay far more for their health service and have far higher standards as a result. No GP's here, there's a collection of specialised doctors in every little village.
Mark M. Newdick, USA/UK
How about a £10 deposit, returned when you keep the appointment or cancel at sufficient notice?
If I only had to pay £10 to see a doctor here in France I would be laughing. However, it is worth it. The system here in France is excellent in both doctor's surgeries and the hospitals. The waiting times are minimal and the quality of health care is, in my opinion, second-to-none.
Last time I went to the doctor (August 1997) she took one look at me, gabbled something unintelligible and practically threw a prescription at me. In and out in less than 5 minutes. Should I really pay £10 for that, on top of the £5.75 the prescription cost me? I knew what I needed, but the pharmacist wouldn't sell it to me without a prescription!
£10 a visit may not seem a lot to some, but
for the poorer people amongst us
(and I don't necessarily mean the
unemployed for which the fee would
be waived anyway no doubt) it is a substantial proportion
of their weekly income.
It might deter time wasters - but it might
also deter poorer people from seeking
medical help when they genuinely need
Craig B, UK
My [private] GP already charges me for visit - but it's a small
price to pay for same-day service, a choice of times to visit, and
no sense that he wants me out of the surgery as soon as possible so
he can get to the next patient in the queue. I believe we should adopt the
model which quite a few European countries use, where you are charged for GP and
hospital visits, but then your insurance pays you
back after the event.
When free prescriptions are made available to those on benefits the number of prescriptions for basic painkillers increases, as these people with nothing better to do can use up the doctor's time to request something free rather than pay a couple of quid for it at Boots. If a nominal fee were introduced it would discourage this kind of time-wasting and allow people to get to a doctor when they need to, rather than when the doctor has finished with the plethora of trivial cases.
Scrap the appointment system. It's useless anyway. I could never get to see my Doctor within 48 hours unless I could convince the receptionist I was seriously ill. If people could turn up and queue then they would see their Doctor as needed. This system works very well in France and French people accept that a lengthy wait is par for the course. Malingerers and habitual "no shows" don't exist.
Now having moved overseas to Singapore I'm impressed with the system here. GP's are essentially private but closely monitored. Standard consultation fees would be about 5 or 10 pounds including medicines. Usual these costs are reimbursed by most employers. Waiting time is usually 5 or 10 minutes - it's a walk-in system. Should you have to be seen at a hospital these is a system of payment based around a Medisave fund which all employed persons pay into over there working life.
I'm not sure about £10 being charged for visits to the GP but a charge should definitely be imposed on the hypochondriacs and drunken yobs that typically frequent many hospital A and E units and abuse or assault the staff.
In Canada, most doctors and dentists have a policy of charging $20 (£10) for missed appointments, but it's frequently waived on compassionate grounds etc. The policy is usually posted in big print at Reception, and mostly serves as a disincentive to no-shows.
If this comes about then I want a refund or reduction in National Insurance.
Rather than charge everyone £10 for each appointment to reduce non attendance, why not charge that amount to those who have not turned up? I know that I am not a rocket scientist but it seems to make sense?
It is already outrageous to have to pay to see a dentist. I expect the outcome will be the same with doctors - people will not visit. I have not seen a dentist for years as I object to paying £20 for someone to say "Keep up the good work Mr. Cowdery". Whatever happened to free healthcare?
There is very little incentive for doctors or their administrative staff to treat patients with respect. A fee-paying system which included more freedom of movement between surgeries would have to be a good thing, encouraging patients to demand more of their relationship with their doctor. As long as there were exemptions for poorer people, it would not be a bad thing.
Free health care is one of the things which Britain can still be proud of, and we certainly shouldn't be discouraging people from checking out symptoms of potentially serious diseases.
John B, UK
Early detection of illness often results in simpler, cheaper treatment. Charges will deter people from seeking help until conditions have worsened and the treatment becomes more expensive. As a means of reducing missed appointments, charging patients is a very shortsighted solution
In a word yes. Anything free nowadays will be abused by the users. It might also mean that we could have an appointment when one is actually in need of it rather
than two weeks later.
A set fee would soon result in longer consultations and longer waiting times as both doctors and patients strive for value for money. For a fun packed afternoon, try sitting in a French doctor's waiting room and you'll find very few patients spend less than half an hour with the doctor.
The quality of most NHS GPs is so low that £10 is too much.
What have we paid our National Insurance for? It would be cheaper for us to take out our own private cover and get better service. As it is, with lots of doctors you have to make an appointment about three weeks in advance, and we don't always know when we are going to be sick.
Last winter when our hospitals were overflowing, much talk was made of how "the French manage to cope". What wasn't mentioned was the fact that the French pay for their doctor's appointments at point of service, thus giving much needed extra revenue to their health service. Most working people could afford to pay perhaps £5 for their appointments; those on benefits of any kind would obviously not have to. I don't see much wrong with this proposed system. In my doctor's surgery there is a notice of how many people failed to attend in the previous month - usually it's at least 100. They should definitely pay!
Removal of student grants, introduction of tuition fees and now £10 to see the doctor. So when are we paying citizens going to see tax cuts? Or are we paying twice for everything now??
I think the system for obtaining appointments is bad enough without putting up new barriers. I commute daily to London, work long hours and have to resort to taking time off work to visit my GP as surgery hours are only available while I am at work and there is no weekend surgery.
Why not charge people who miss an appointment rather than force everyone else to pay instead. If they persistently miss appointments, they could always be refused them in future or charged an even bigger fine.
I know what, I'll go into competition with my GP and only charge people £5 a go to be told to take some aspirin, go to bed and stop bothering me.
Eileen George, UK
What about those medications where it is necessary to have regular check-ups?
For example, the contraceptive pill is currently free, but since it cannot be put on repeat prescription charging for appointments would essentially raise the cost to ten pounds per prescription!
What about call-outs? Charge across the board for them as well? It might dissuade people from abusing the service, but it might also dissuade the people who actually need it.
If the majority of the population actually ate properly, exercised and stopped spending the night on the couch watching mind numbing TV programmes then perhaps they would not need to visit their doctor. Good health comes from within, not from a prescription from the doc. Instead of visiting the doctor to let them know you feel lethargic, get out and go for a long walk, drink and eat properly and learn to relax. It's not the doctor's fault we can't look after ourselves.
To charge for every visit would be wrong. Each person should have an annual allowance of free visits, say 6 new consultations per year. After that follow-ups and children's appointments can be free.
Yes, I think it is a good idea or at least something similar to our system in Belgium. You pay the doctor FB580 (8.90 pounds) and are later reimbursed FB380 (5.85 pounds) by the national insurance. This would take some pressure off the Government's support of the National Health or would allow those taxes to be better used for shortening waiting lists etc (which we do not have over here). If there are families with real financial problems they could be exempted from payments.
If my appointment with my GP was on time (never has been) I may consider paying the £10. To pay this and see no improvement in service would probably be the outcome
Who has the time to visit the doctor for "frivolous" reasons?
I suspect that it is the very people who wouldn't have to pay anyway - those who are out of work.
The proposed £10 charge would effectively prevent hardworking families from consulting the doctor at all until desperate. This could result in vital treatment being delayed.
I cannot believe this will be implemented. It seems hard to imagine that
GP practices don't know which patients are unreliable or late for appointments. Perhaps like the dentist they should make a charge for this reason. I cannot see why the majority should have to pay for the thoughtlessness of the minority.
21 Aug 00 | Health
Support grows for £10 GP charge
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