You’ve seen the ads: Friends provident, which was spun off from the same medical startup as the old Provident Medical Ventures, is offering a new service called the Medicare Fiscal Intermediaries, which is designed to help patients get paid for their medical care.
The service, which the company has dubbed the “Medicare Fiscal Authority,” can be used by patients to get payments from doctors and hospitals when they need them.
The fee-for-service model is an approach that has been widely adopted in the health care sector, but it’s one that’s been criticized by some health experts, who say it creates a financial incentive for doctors to withhold care from patients.
(See related: What’s the difference between Medicare and Medicare Advantage?)
That criticism comes in part because the fee-based model is typically seen as a way to reduce the amount of care patients need.
But, in addition to raising the financial risk for patients, it also puts doctors in a position of negotiating for better terms for their patients, experts say.
The idea that it’s a good idea to help doctors keep some of their income comes down to one of two points: Either doctors are paying the bill or patients are paying for the care.
In practice, the second one is the more important point.
The more a doctor makes off of the fee, the more the hospital can profit from the services it’s providing.
But even though patients are ultimately responsible for the cost of their health care, they are still in a very bad financial position.
“I think it’s really important that we recognize that this is the first time in our lives that we’re seeing this,” says Elizabeth Wysocki, a medical ethicist and a professor of clinical medicine at the University of Toronto.
“In the US, we’ve seen some changes in the cost curve, and I think it’ll take a while for it to sink in for patients.”
One problem with fee-free health care has been that doctors are under pressure to make their patients comfortable with their services, experts agree.
The pressure can be great.
One study found that more than half of the physicians surveyed had seen patients with major chronic illnesses who had refused to be seen by them, including many who were suicidal or who had been hospitalized.
When doctors see patients in distress, they often do things like refuse to do basic tests or antibiotics, according to Wysocksi.
“When I see patients who have no insurance, they’re going to make a very good argument that they can’t afford it,” she says.
That’s because the medical community is already under pressure.
The U.S. Census Bureau reports that in 2016, the total amount of health care spending in the United States was $7.4 trillion.
That amount dwarfs the gross domestic product of the entire European Union, which stands at $4.5 trillion.
And when it comes to health care in the U.K., health care costs are on average a quarter of GDP, according the Institute for Fiscal Studies.
The financial impact of fee-and-wait medicine is a problem in a lot of countries, Wysampi says.
The Netherlands has a similar system called the Hospitalas Health, which focuses on patients who need high-cost care but don’t have a reliable source of income.
But the Dutch system isn’t entirely free of problems.
It has an average annual fee of just $1,400 per patient.
And the country’s health care budget is projected to increase by 7% this year, Wiesampi points out.
Wysamps research has found that the fee model can be a useful tool for helping doctors, but that it can also lead to problems.
“What you end up with is a system where you’re incentivizing physicians to withhold their services from patients,” she tells The Salt.
“You’re incentivising doctors to pay patients less than they should.”
What the research shows is that when physicians do decide to withhold services, the practice is often based on the assumption that patients are willing to pay less than the doctor is willing to.
“That’s a pretty poor model for how to get the cost down,” says Wysoks research assistant Jennifer Jonsson.
“And that’s really a big concern.”
The problem, experts argue, is that the fees don’t take into account the fact that patients often need more services, including prescription drugs, to function properly.
And they can also be too low in relation to inflation.
For example, in some cases, a doctor could charge a patient $400 per month to get a prescription refill, while in other cases a patient could pay the doctor $200 for the same medication.
A study from the University at Buffalo looked at the fee structure in 10 countries and found that fees in most cases didn’t take account of inflation and that some of the countries charged more for a single prescription than a year or even two.
It’s not clear what the impact would be