Balance billing
Balance billing, sometimes also called extra billing, is the practice of a healthcare provider billing a patient for the difference between what the patient's health insurance chooses to reimburse and what the provider chooses to charge.
Advocates of balance billing argue that it increases the incomes of high-quality healthcare providers, and serves as a measure of their dissatisfaction with insurance company fees.[1] Critics say that balance billing lets providers raise charges through stealth rather than transparent pricing, creates unnecessary administrative costs and patient confusion, and allows insurers to simply pass along costs to patients, rather than helping them to secure good value.[2] It is thought to erode political consensus in favour of a one-tier system of healthcare, and to inhibit some people from getting the care they need, by making that care more expensive.[3]
Canada
Throughout the 1970s in Canada, the country saw an increase in balance billing, which in Canada is normally called extra-billing. It was not permitted in Quebec or British Columbia, but had been encouraged in Ontario and Alberta, and tolerated in other provinces. The federal government estimated that by 1983, extra-billing across Canada totalled $100 million. The government believed that extra-billing was enabling the creation of a two-tiered Canadian healthcare system, in which people who couldn't afford extra charges would receive lesser care. In 1984, the government passed the Canada Health Act promising universal and comprehensive health coverage for all Canadians, which contained provisions to discourage user fees and extra-billing by imposing financial penalties on, and reducing transfer payments to, provinces which permitted them.[4][5][6] Today, five provinces prohibit all extra-billing, while Alberta, British Columbia and Newfoundland allow it in a small number of circumstances, and Prince Edward Island and New Brunswick do not restrict it at all.[7]
France
In France, physicians who want to charge more than the government-negotiated set fees are considered to be in a separate "payment sector," which essentially means they are treated as self-employed. They can charge higher fees, and receive reduced benefits. In 1987, about 27% of French physicians chose to balance bill. The percentage is higher for specialists rather than generalists, and for doctors in urban rather than rural areas.[8]
Germany
Balance billing is prohibited in Germany. Fee schedules are negotiated between sickness funds and physicians, and physicians are not permitted to charge more than the set amount.[9]
Japan
Balance billing is prohibited in Japan, and extra fees are only allowed in a small number of circumstances, such as having a hospital bed with extra amenities.[10]
Taiwan
Balance billing is prohibited in Taiwan, and extra fees have only been allowed recently, and in rare defined circumstances. Today, patients in Taiwan are allowed to choose more expensive versions of some devices such as stents, implants or prosthetics, and to pay the difference in cost themselves.[11]
References
- ^ Holahan, John, Lynn Etheredge (1986). Medicare physician payment reform: issues and options. Washington DC: The Urban Institute. p. 109. ISBN 0-87766-395-5.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ Porter, Michael E., Elizabeth Olmsted Teisberg (2006). Redefining health care: creating value-based competition on results. Boston, Massachusetts: Harvard Business School Press. p. 338. ISBN 1-59139-778-2.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ Bennett, Arnold, Orvill Adams, Families United for Senior Action Foundation (1993). Looking north for health: what we can learn from Canada's health care system. Jossey-Bass/Aha Press Series. p. 173. ISBN 1-55542-516-X.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ McEwen, Nicola (2006). Nationalism and the state: welfare and identity in Scotland and Quebec: Regionalism and Federalism. Brussels, Belgium: P.I.E. Peter Lang SA. pp. 128–9. ISBN 90-5201-240-7.
- ^ Dunn, Sheilagh M. (1982). The year in review, 1982: intergovernmental relations in Canada. Kingston, Ontario: Institute of Intergovernmental Relations. pp. 180–182. ISBN 0-88911-038-7.
- ^ Porter, Michael E., Elizabeth Olmsted Teisberg (2006). Redefining health care: creating value-based competition on results. Boston, Massachusetts: Harvard Business School Press. p. 338. ISBN 1-59139-778-2.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ Sullivan, Terrence James, Patricia M. Baranek (2002). First do no harm: making sense of Canadian health reform. Toronto, Ontario: Malcolm Lester and Associates. p. 44. ISBN 0-7748-1016-5.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ Thompson, Lawrence H. (1992). Health Care Spending Control: The Experiences of France, Germany & Japan. United States General Accounting Office. p. 40. ISBN 0-7881-0574-4.
- ^ Thompson, Lawrence H. (1992). Health Care Spending Control: The Experiences of France, Germany & Japan. United States General Accounting Office. p. 41. ISBN 0-7881-0574-4.
- ^ Ikegami, Naoki, John Creighton Campbell (1996). Containing health care costs in Japan. University of Michigan Press. p. 10.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ Okma, Kieke G. H., Luca Crivelli (2009). Six Countries, Six Reform Models: The Healthcare Reform Experience of Israel, The Netherlands, New Zealand, Singapore, Switzerland and Taiwan: Healthcare Reforms "Under the Radar Screen". World Scientific Publishing Company. pp. 179–180. ISBN 981-4261-58-0.
{{cite book}}: CS1 maint: multiple names: authors list (link)
Further reading
- Glazer J, McGuire TG (October 1993). "Should physicians be permitted to 'balance bill' patients?". Journal of Health Economics. 12 (3): 239–58. doi:10.1016/0167-6296(93)90010-C. PMID 10129837.
- McKnight R (March 2007). "Medicare balance billing restrictions: impacts on physicians and beneficiaries". Journal of Health Economics. 26 (2): 326–41. doi:10.1016/j.jhealeco.2006.09.001. PMID 17034888.
- Colby DC, Rice T, Bernstein J, Nelson L (1995). "Balance billing under Medicare: protecting beneficiaries and preserving physician participation". Journal of Health Politics, Policy and Law. 20 (1): 49–74. doi:10.1215/03616878-20-1-49. PMID 7738321.
- Lomas J, Fooks C, Rice T, Labelle RJ (1989). "Paying physicians in Canada: minding our Ps and Qs". Health Affairs. 8 (1): 80–102. doi:10.1377/hlthaff.8.1.80. PMID 2707723.
- Ikegami N, Campbell JC (2004). "Japan's health care system: containing costs and attempting reform". Health Affairs. 23 (3): 26–36. doi:10.1377/hlthaff.23.3.26. PMID 15160800.
- Christensen S, Long SH, Rodgers J (1987). "Acute health care costs for the aged Medicare population: overview and policy options". The Milbank Quarterly. 65 (3): 397–425. JSTOR 3349945. PMID 3119975.
- Holahan J, Zuckerman S (1989). "Medicare mandatory assignment: an unnecessary risk?". Health Affairs (Project Hope). 8 (1): 65–79. doi:10.1377/hlthaff.8.1.65. PMID 2651265.
- Lee PR, Ginsburg PB, LeRoy LB, Hammons GT (April 1989). "The Physician Payment Review Commission report to Congress". JAMA. 261 (16): 2382–5. doi:10.1001/jama.1989.03420160114033. PMID 2649697.
- Thompson, T. Scott (August 31, 2010). "Out-of-network involuntary medical care: An analysis of emergency care provisions of the Patient Protection and Affordable Care Act". Bates White.