By NextBestFitTwo-tier care: a private fast lane for those who can pay
Where private insurance or cash practice exists alongside a public system (UK, Australia, Germany), those who pay get faster care, and providers' time shifts to them.
Evidence
- Privately insured patients in Germany get specialist appointments faster.
Who's affected
- People relying on publicly funded care: Private fast lanes draw provider time away from public care.
- High earners: Paying privately buys faster care.
- Cash-pay and private care practices: They earn revenue from the private fast lane.
Under your mix of paths
- Higher private prices attract provider time
Related costs
Open questions
- Should private insurance for publicly covered services be allowed?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Public coverage alongside private insurance can preserve faster elective access for people buying private coverage, as in the cited Australian example.
Private coverage for extras allows people who can pay to obtain better care.
Solution paths (3)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
People may buy private insurance to skip public queues.
- +Longer waits if demand grows faster than capacity
No private insurance for publicly covered services.
- +Two-tier care: a private fast lane for those who can pay
- −Longer waits if demand grows faster than capacity
- −Faces political, industry, or legal opposition
Private insurance only for things not covered (private rooms, cosmetic).
- +Two-tier care: a private fast lane for those who can pay
- −Requires difficult enforcement
- −Solves only part of the problem
Also addressed by paths for other problems
Barring opted-out clinicians from public billing limits mixing public and cash-only practice and helps limit a private fast lane.