Analogy does not apply

Dr Ladouceur’s restaurant analogy in his May editorial¹ is inapplicable and nonsensical. Restaurant owners set their own “fees” to cover their costs and increase them based on market forces and cost increases. A third party determines the fees for physician services and, most importantly, determines which of those services are covered. The third-party payer has no interest in educating the customer as to what is covered and leaves it to the physician to either absorb that cost or pass it on to the consumer. Furthermore, goods and services in Canada are laden with hidden costs. The advertised price has goods and services and provincial sales taxes added after the fact and, if a restaurant, gratuity is not included.

It is a fact of human nature that services provided for free are devalued and become expected. Just as taking the time to explain why an antibiotic prescription is not necessary decreases re-presentations expecting antibiotics, educating patients (and employers!) on the costs of what is not covered by Medicare decreases unnecessary repeat requests that creep into the publicly funded domain. By instituting an automated recall system and charging for no-shows, our clinic has dramatically decreased no-shows and thus decreased wasted appointments and improved accessibility. Not charging (fairly) for uninsured services and not reinforcing to patients that there is a cost for not showing up for their appointments perpetuates the unsustainable delusion that Medicare should “just pay for everything.” This actually increases costs to the public purse and threatens the sustainability of publicly funded health care.

• Copyright© the College of Family Physicians of Canada