Should patients pay for public healthcare?

The understanding that government healthcare should be available free of charge to all who need it sometimes overlooks the real cost that patients have to pay in order to access healthcare services.

November 10, 2020
Paul Bitarabeho & Le Beau Taljaard

While recipients of care may not pay to be seen by a healthcare worker at a government facility, the amount that the experience will have cost them in travel time, transport fees and lost income needs to be considered. If there were a way to reduce the net cost for people while requiring them to pay more directly for access to healthcare, should it be implemented?

While the solution wouldn’t be universally applicable, there is a strong case to say that patients would be willing to pay something towards a more convenient healthcare experience for some services, like medicine collection, especially if it saved them time and money in other ways.

The value of free services

There is some debate about whether asking people to contribute a nominal fee for a service garners greater commitment from them when using the service. Healthcare, however, is different as patients are dependent on whatever health facility is available in their community and healthcare is an essential need that can’t be opted out of if one doesn’t want to pay.

However, when reimagining aspects of healthcare to bring better experiences to recipients of care, there is room to explore partially patient-funded solutions. In Uganda, there is a good example of how this could work. There is currently a pilot underway for a differentiated service delivery model for rural communities. In the pilot, communities are asked to contribute towards the cost of transporting healthcare workers to their village.

Rather than paying to transport themselves, and the exponential cost they incur if they also need to take a family member with them to a district health facility, a group of people in a village can each contribute a portion towards the healthcare workers’ transport to the village, where multiple members of the community can then receive healthcare services and medicines.

An analysis in the investment case for the pilot showed that there was a cost reduction of about 82% for the patients as a result of them contributing towards this model.

What seems to be a strong driving force in people’s willingness to contribute to healthcare services is the need for assurances. If people are going to pay, they want to know that they will receive good quality care in return.

A number of reports show that where governments haven’t been able to fully fund a particular medicine or service, and the option to pay has been opened to the public, people are willing to contribute as long as they are given assurances that they will actually receive the service or product they require. In this way, the public recognises that there is a shared burden around healthcare, but governments don’t always see this and trust can be eroded if a government doesn’t hold up its end of the bargain by providing the requisite services.

Policy shift

There is understandably some reluctance to turn what is an informal reality for patients, where they pay high costs to get to healthcare facilities but receive the services themselves for free, into an institutionalised system where the service is paid for more directly. This requires a shift in thinking that could take time to work its way through policy and regulatory systems.

The concept of universal health coverage incorporates an understanding that governments don’t take on the burden of care for everything, and that they are rather supposed to explore ways to get support, whether from the public or another channel, to enable them to provide services to the public. Part of improving healthcare for all who need it includes expanding the system itself, which requires significant financial resources. If some aspects of expansion will offer more accessible healthcare to people in exchange for a small fee, it could boost the speed at which healthcare systems are able to grow, and will directly benefit recipients of care.

One of the important cautions around payment for government healthcare is that it should not create further segmentation and prejudice the most vulnerable groups in a community who aren’t able to pay. If used well, public contributions to certain healthcare services could decongest facilities, increase capacity in the public health system and ultimately lead to improved healthcare delivery for everyone, including the most vulnerable.

About the authors

Paul Bitarabeho has over 23 years’ experience in supply chain management in the FMCG industry. He has worked with Coca-Cola in Africa and Asia, Uganda Breweries and Kenya Breweries Ltd, all subsidiaries of Diageo and In Nile Breweries, in supply chain management, Sales and Human Resources at Director Level.

Le Beau Taljaard has over 25 years’ experience delivering growth for clients and his own organizations in the FMCG industry. He gained significant experience and expertise in the Route to Market and Supply Chain with the Smollan Group where he participated in and led new business development, establishing new business units, operational implementation, operational/general management and client interaction.

They have both spent the last 18 months in the Public Health arena supporting the Uganda Aids Control Program (ACP) in developing Alternative Drug Distribution Points (ADDP) for the Aids Control Programme in Uganda with a view to leverage these models to more than just ARTs.