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[ This message has been sent to you via the CASI-analysis mailing list ] Colin remarks > From an efficiency point of view, pay per service is felt to be superior to > payment through, say, income taxes, and then free at point of use: the > resources cost something to provide, but if users can draw on them 'for > free', then they will not face the same incentives to ration the use of > expensive resources. From an equity point of view, this can be very > regressive: the poor and otherwise socially disadvantaged may be more likely > to fall ill or suffer from chronic illness. > Colin notes that the charges may increase the degree of inequity. But what exactly is meant by "efficiency" here? If efficient means optimum allocation of scarce resources to satisfy medical needs on the basis of need alone it doesnt seem efficient at all. User charges will only deter those who have scarce dollars others will continue to use the resources when they dont need them and that doesnt seem efficient. For the poorest they may not seek needed medical help at all and that is surely not efficient in using scarce resources to meet medical needs on the basis of need. So what sense of efficiency is meant in thuis context? Colin puts "for free" at point of use in scare quotes. Of course it is not free but is paid for from taxes or the like. Even from some economic view of efficiency it doesnt seem clear to me why this would be less efficient. In terms of results medical systems primarily funded through tax dollars rather than user pay cost less and produce at least as good results as systems such as the US where user pay is used more. It is true that expansion of user fees is fairly common but this has nothing to do with efficiency except as an excuse to move costs from public to private pockets. There may be little or no decrease in costs and almost always an increase in hardships for the worst off. Note that Colin makes use of the phrase an efficiency point of view. This is some sort of anonymous point of view that has great authority I guess but it is not at all clear what it is or who holds it. It sounds like a phrase from some neoclassical economics catechism. Even the idea that having no charges at point of use will cause overuse of system is doubtful in the case of medical care. People will not break their legs or try to get diseases so as to get free medical care. To avoid inequities programmes may be developed to target the less well off, programmes that have costs to administer. While some people may want medicines they dont need most of us are happy enough to do without more pills even if they were "free". From the efficiency point of view I guess even health insurance however financed would be inefficient since the insured does not pay at point of service. Cheers, Ken Hanly _______________________________________ Sent via the CASI-analysis mailing list To unsubscribe, visit http://lists.casi.org.uk/mailman/listinfo/casi-analysis All postings are archived on CASI's website at http://www.casi.org.uk