By NextBestFitOnly flat, small charges on a few services
Limit charges to a few flat fees (e.g., a small emergency-room fee for non-emergencies, a per-prescription fee) with exemptions for children, the poor, and chronic illness.
Zero cost sharing chosen.
Review ledgerHow this path connects
No new problems identified.
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Set a few flat fees with exemptions
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Copays keep billing systems alive and still deter poorer patients
Limiting charges to small flat fees on selected services simplifies charging and targets specific overuse, with exemptions for children, poor people, and chronic illness. Collection is still needed, and charges still deter near-poor patients.
- Low-value care and overtreatment
Small flat charges for selected services, such as non-emergency emergency-room use, target specific overuse.
None identified.
Who's affected
- Low- and middle-income households
- Copays keep billing systems alive and still deter poorer patients: Point-of-care charges deter care, especially for poorer patients.
- People with ongoing or specialist care needs
- Copays keep billing systems alive and still deter poorer patients: Point-of-care charges deter care, especially for poorer patients.
- Low-value care and overtreatment: Low-benefit tests and treatments expose them to harm.
- Hospitals, clinics, and care organizations
- Copays keep billing systems alive and still deter poorer patients: Copays require collection, exemptions, and billing work.
- Health insurers, brokers, and their shareholders
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Taxpayers and public budgets
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Health administration and software vendors
- Copays keep billing systems alive and still deter poorer patients: Copays preserve demand for billing services.
- Low- and middle-income households
- Copays keep billing systems alive and still deter poorer patients: Limiting charges to small flat fees on selected services simplifies charging and targets specific overuse, with exemptions for children, poor people, and chronic illness. Collection is still needed, and charges still deter near-poor patients.
- Hospitals, clinics, and care organizations
- Low-value care and overtreatment: Per-service payments reward additional low-value care.
- Drug and device makers
- Low-value care and overtreatment: They sell devices and tests used in low-value care.
- Prepayment certificates that cap annual charges
Where it has been tried
- UK (England): Flat prescription charge with about 89% of items dispensed free due to exemptions.
- United Kingdom (England): In England, where the NHS levies a flat prescription charge, approximately 89% of items dispensed in the community are free of charge due to age, medical, and income exemptions (2023).