No. I’ve got three prescriptions. One I’ve had for over 10 years, the other two for about a year. Never paid a penny (if we still had them).
Plus, the only way I can get a prescription filled is if a doctor, in their professional judgment, concludes I need a certain medication. Where is the “moral hazard”? I’m not the one who decides whether I’m eligible for a prescription; a medical professional has made that call.
It’s a “moral hazard” to fill a prescription recommended by my doctor?
Why is there this idea of “moral hazard” for a government service? I pay for it with my taxes, just like I pay for police services and fire services with my taxes.
But there’s no suggestion of “moral hazard” if I call 911 because I’m worried someone may be committing a crime on my street, or if I’m worried that flickering lights I see next door may be a fire. The attitude of cops and firefighters tends to be “better safe than sorry”, and there’s no charge.
Health care is just another government service. If you have a spot suddenly on your skin, it could be a rash, most likely is, but it could be melanomia. Better to have it checked out, and if it’s just a rash, well, better safe than sorry. No charge.
Ok, then you’re on some special plan. I mean, I’m just repeating what you said earlier!
And to repeat my earlier link about co-pays:
https://www.canada.ca/en/patented-medicine-prices-review/services/npduis/analytical-studies/supporting-information/2020-2021-public-drug-plan-designs.html
You’re muddling different issues. Prescription drug and dental coverage have co-pays because they don’t fall under the Canada Health Act governing universal health care. For most employees they’re covered under employer-provided private supplemental insurance, and for retirees under government programs separate from the universal health care program.
But for universal health care, although it’s provincially administered, the federal government established national guidelines that all provinces must conform to. As part of those guidelines, the government made a deliberate decision to prohibit co-pays, extra billing, or any other monetary transaction between patient and provider for medically necessary procedures. Clearly, they did not believe that this introduced any “moral hazard”, and it doesn’t.
The main reason for co-pays is to (a) discourage use, and (b) lower the insurer’s costs. Point (a) can be a significant health hazard to those of limited means who may choose to avoid doctors or the ER when it’s critically necessary that they get medical attention. The reason that the Canada Health Act explicitly prohibits co-pays is the principle that financial means must never be an obstacle to health care. The implicit assumption is that very few people are interested in going to the doctor or the ER for the sheer fun of it.
911 abusers are commonplace and most places have laws against using it frivolously. Some people will call 911 just to have someone to talk to, whether due to mental illness or otherwise. There are absolutely mechanisms to avoid the moral hazard. As I said, it doesn’t have to be a fee, but there had better be something.
Some resources just can’t be abused that way–like roadways. One person can only drive one car at a time (as an aside, self-driving cars may well change the picture here). But other services are easy to abuse, including 911.
No, I’m not. You don’t need co-pays for services that are paid for. The payment is what eliminates the moral hazard.
The various prescription drug do (generally) have co-pays in Canada, for exactly the same reason why US drug plans have co-pays.
And again, a co-payment is not the only mechanism by which you can eliminate the moral hazard. You just need an obstacle of some kind. Sometimes the nature of the service is enough. No one is getting gallbladder surgery for kicks, but the same is not necessarily true of drugs.
I imagine that, reflective of the model of US health care, one of the “services” the third-party health insurance company provides is vetting of claims and denying them wherever possible, even though they’re not the ones paying the claims.
And losing the contract if they aren’t aggressive enough.
Please remember that Canada’s health service does NOT cover prescriptions. They cannot be used as an example of how nationalized health coverage works
Yes, and the reason is that they are run by private companies.
You are. You’re muddling services that fall under medically necessary health care, governed by the Canada Health Act, with other stuff like prescription drugs.
I have no idea what this is supposed to mean.
This is the point I keep making over and over again. No one goes to the doctor or to the ER for the fun of it. We have no deductibles and no co-pays for medically necessary procedures. No “moral hazard” has been observed. Yet in the US, co-pays and deductibles exist for these procedures, even if they’re life-saving necessities. Why?
Sometimes these extra costs can be ruinously expensive, to the point of precipitating personal bankruptcies. Why? Who does that help?
No, it’s equally true. I can only get a prescription if a doctor feels I need it. I can’t get prescribed drugs because I think they’re fun, but even if I did, the $4 dispensing fee for a 3-month supply (the only cost involved that could be considered a co-pay*) would not be a disincentive! Conversely, if I really need a drug, cost will generally not be a factor. In economic terms, prescription drug demand is inelastic and not materially influenced by price.
* - I’m referring here to government drug plans for those over 65 and other eligible residents. Private supplemental insurance will usually have explicit co-pays mandated by the plan.
I can’t fathom what’s so hard to understand. Again, with the soda example:
Why don’t you think it would be a disincentive? It’s not a disincentive to anyone that needs the drugs. But it is for someone that is being intentionally wasteful.
And yet, the 911 system still functions and isn’t totally overwhelmed by people calling just to chat. I’m sure there’s some mechanism to prevent abuse, but they seem to have managed it without charging everyone a fee for every 911 call.
I’m talking about the various public drug plans as in this document:
https://www.canada.ca/en/patented-medicine-prices-review/services/npduis/analytical-studies/supporting-information/2020-2021-public-drug-plan-designs.html
They basically all have co-pays or something equivalent.
Whether the service is provided by the public or private party is irrelevant. The moral hazard exists whenever there is a great disparity between what something costs and what another party “pays” for it. I put “pays” in quotes because the cost is not necessarily monetary, and could be something else like (in)convenience. Co-pays have an explicit monetary cost, though.
Again, the soda example is completely irrelevant, because people LIKE soda. They don’t like going to the doctor. The whole concept of “moral hazard” as applied to health care is ridiculous.
These same for-profit health insurance companies that deny people expensive life-saving treatments actively encourage people to get regular checkups by making them free, because it’s in their interests to keep their customers as healthy as possible – one in the Chicago area is advertising that they will actually PAY you $50 for getting an annual physical.
The cost in morbidity and mortality from *under-*use of medical services is a real problem; the cost of unnecessary care provided to the tiny group of mentally ill over-users is not.
How many times do I have to repeat that co-pays are not the only mechanism to avoid the moral hazard? Hopefully no more than a few dozen.
Co-pays are however a very common mechanism, especially in the case of prescription drugs. Even in Canada and the UK.
Laws are another possible mechanism. A heavy-handed one, but one that works in the case of 911. I don’t know if abuse of healthcare services is similarly illegal in Canada.
It’s often easy for “statistically insignificant” abusers to cause statistically significant costs if there is nothing stopping them. As with the case of 911, where most people might call in once or twice a lifetime, whereas abusers might call hundreds of times a day.
The statement that made no sense to me was “You don’t need co-pays for services that are paid for.” I guess it was just a disconnect between your wording and my understanding. I mean, our health care for medically necessary procedures is fully paid for, but you still argue that there is a “moral hazard” of overuse without a co-pay. But then you acknowledge that no one would get medical services just for the fun of it, so your “free soda” example is irrelevant, and I don’t know what your position is any more.
And you didn’t answer this question:
No one goes to the doctor or to the ER for the fun of it. We have no deductibles and no co-pays for medically necessary procedures. No “moral hazard” has been observed. Yet in the US, co-pays and deductibles exist for these procedures, even if they’re life-saving necessities. Why?
Sometimes these extra costs can be ruinously expensive, to the point of precipitating personal bankruptcies. Why? Who does that help?
Would you care to describe how someone could be “intentionally wasteful” with regard to drugs for which you need a prescription?
One might hypothesize someone addicted, say, to opiods, who engages in “doctor-shopping” to get as many prescriptions as possible. In today’s computerized electronically-connected world, and with the medical community paranoid about addictive drugs, I really doubt this would work any more. But supposing for a moment that it did. Do you think that $4 is going to stop a drug addict from getting his fix?
This whole rabbit-hole about prescription drugs is a red herring. The costs are generally minimal, and exceptionally expensive drugs will often be covered under special programs under the primary health care system, or are administered in hospital where they’re automatically covered.
The only really important issue here is that medically necessary medical procedures, which are often life-saving or essential for preserving the patient’s quality of life but which can also be extremely expensive, should always be fully covered as they are in Canada, and never subject to denials.
What would you consider “abuse” of healthcare services? Do you think people are going to take more insulin than their doctor prescribed just because they don’t have to pay for it?
I imagine that in Canada the tiny group of people who show up daily at their doctor’s office demanding an MRI to reassure themselves that they haven’t developed cancer overnight are treated much the same way they are in America; first you try to reassure them that what they think they need isn’t actually necessary, then you refer them to mental health services, and if all else fails you just stop letting them into your office. (Canadians may have a right to health care in general, but they certainly don’t have the right to be seen by any particular doctor). The only difference being that the Canadian doctors don’t have any financial incentive to do the unethical thing and order the unnecessary tests.
I need a cite for that, because I would think that after just a few bogus calls to 911, the police would get involved.
My knowledge of Canadian Healthcare is out of date, as my source of information was my husband, and he passed away in 2018
This guy called 911 403 times over two years to report that “hipsters” were infesting his neighborhood, but they didn’t arrest him until he escalated to actually making false crime reports. But that’s New York, other jurisdictions may have a lower threshold.
Latreasa Goodman of Fort Pierce, Florida, was cited for misusing 911 after she called it three times on Saturday to report that a local McDonald’s had run out of McNuggets.