Universal HealthcareBy NextBestFit
Problem · Problems created by solution paths

Copays keep billing systems alive and still deter poorer patients

Any point-of-care charge requires billing, collections, exemptions, and caps, and even small charges deter low-income patients more than others.

Evidence

  • The RAND Health Insurance Experiment found cost sharing reduced both needed and unneeded care.
    Sources: RAND Corporation (1986)

Who's affected

Who is hurt
Who gains while it lasts

Under your mix of paths

Paths that create or worsen it
Paths that fix or soften it
Using your saved plan. 0 paths picked.Edit all picks
Root causes
  • Charging at the point of care

Open questions

  • If charges exist, who is exempt, what is the cap, and how is it collected?

Caused or worsened by these paths

This problem only matters if one of these paths is chosen.

Modest copays with an income-based annual capUnderinsurance: covered, but can't afford to use itRejected

Retaining copays still deters some needed care and requires billing and income verification.

Value-based cost sharingUnderinsurance: covered, but can't afford to use itRejected

Tiered cost sharing still requires claim-level billing and tracking.

Private supplemental plans for extrasLosing the choice of health plan and insurer competitionChosen

The cited complementary insurance model covers statutory cost-sharing, keeping a role for plans that handle patient charges.

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.

Automatic exemptions and annual collection through taxesChosen

No money changes hands at the visit. Charges are tallied by the payer, capped by income, waived automatically for low-income people using tax data, and settled once a year on the tax return.

  • +Copays keep billing systems alive and still deter poorer patients
  • +About $1 trillion a year in administrative cost
  • −Weakens incentives for desired behavior
Drop point-of-care charges entirelyChosen

Remove the problem at its source: no copays for covered services.

  • +Copays keep billing systems alive and still deter poorer patients
  • +About $1 trillion a year in administrative cost
  • −Longer waits if demand grows faster than capacity
  • −Raises spending or loosens control over it
  • −Replacing premiums with taxes
Only flat, small charges on a few servicesRejected

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.

  • +Copays keep billing systems alive and still deter poorer patients
  • +Low-value care and overtreatment