Supplementary fee outpatient departments

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

The legislative change is to abolish the special payment category system in public hospitals. To replace the old system the reform introduces a new scheme in which the public hospitals can charge higher fees on services provided at weekends and after 4 pm during weekdays. The system is to provide medical staff extra earnings, to promote more efficient use of hospital equipment and to give the patients more freedom to choose the doctor and timing of the care.

Purpose of health policy or idea

The objective of this legislative change is to abolish patients' possibility to choose their doctor in public hospitals by paying extra fees according to the so called "special payment category" scheme. Most of these extra fees are paid to attending doctors. The system was introduced in the 1950s to compensate the senior hospital doctors' loss of earnings due to the closure of former public hospital wards used by the doctors to treat their private patients. Although not intended, the 'special payment category' scheme has given a possibility to patients to avoid surgery queues by paying these relatively low extra fees to doctors in operative specialties.

While the special payment category was abolished, the reform introduced a new scheme in which the public hospitals can charge higher than normal fees on services provided at special outpatient departments at weekends and after 4 pm during weekdays. The system is to compensate doctors the loss of special payment category fees but in a way that will distribute the earnings more equally among doctors and other hospital staff. It is also claimed to promote more efficient use of hospital equipment and to give the patients more freedom to choose their doctors and timing of the care. The new scheme is an additional system and all patients still retain their former rights to receive care at public hospital outpatient departments at nominal fees during normal working hours.

Main points

Main objectives

Main objectives are to improve equity in access to care by removing the possibility to evade queuing at public hospitals by paying extra fees to the doctors, to promote more efficient use of hospital equipment and to increase equality among doctors and other hospital staff in chances for extra earnings.

Type of incentives

Additional earnings for doctors and other hospital staff   

Groups affected

Doctors working in hospitals, Patients, Other hospital personnel

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

The legislative change was passed in connection to a more fundamental policy reform in which the patients were granted a right to get access to care within certain time limits (see the policy reform 'Ensuring access to health care' (Round 3).  Accordingly the reform did not get much attention in the media.

Political and economic background

In 2001 the Government initiated "the National Project to Ensure the Future of Health Care" originally proposed by the Prime Minister and the Minister of Social and Health Services at the time. The project aimed to solve a variety of ills in the Finnish health care system. One outcome of the project was "the Decision in Principle by the Council of State on Securing the Future of Health Care" issued by the Government in 2002. Among other things, it stated that 'special payment category' system in public hospitals should be abolished.

According to this scheme patients have possibility to choose their doctor in public hospitals by paying extra fees of which most goes to attending doctors. Although not intended, the system has given possibility to patients to avoid queues by opting for it. Due to this inequality there has been pressure to terminate the system.

The system is an important source of additional earnings for some doctors working in public hospitals (especially in the specialties of anaesthesiology, surgery, ophthalmology, pathology and oto-, rhino- and laryngology).

Change based on an overall national health policy statement

The Decision in Principle by the Council of State on Securing the Future of Health Care

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The termination of the "special payment category" system has been debated for several decades, because it fosters inequality among patients in public hospitals and it is unequal for doctors from different specialties. The system also creates an incentive for the non-efficient use of medical expertise. The right to treat patients in the special payment category is only granted for senior doctors but most patients at the special payment category are at hospital due to common surgical procedures.

The introduction of special outpatient departments charging high fees from patients and operating outside normal working hours is a relatively recent idea proposed by some health care experts. Their main objective for this system has been to provide supplementary earnings for doctors and to stop the drain of qualified staff to the private sector.

The main actor behind the reform is the Ministry of Social Affairs and Health.

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

The Finnish Medical Association has opposed the reform strongly because the special payment category system has been an important source of additional revenues for some doctors working at public hospitals. The new system replacing it is introduced partly because it makes the abolishment of the special payment category system more acceptable among doctors. Lost revenues are also partly compensated for doctors by increasing their salaries.

Influences in policy making and legislation

The legislative change will come to effect in the beginning of 2005. There is a three year transition period when the old system is still in effect for those doctors whom the right to treat special payment category patients had previously been granted for.

Legislative outcome

success

Adoption and implementation

The public hospitals are responsible for the introduction of the new system in which they can charge higher fees from patients treated outside normal working hours at special outpatient departments. The legislation only gives an option for the public hospitals to introduce the new system but they are not obliged to implement it. At the moment it is not clear to what extent the public hospitals are going to implement it. Actual ways to implement the new system may vary between hospitals.

Monitoring and evaluation

At the moment there is no explicit mechanism to review or evaluate the process.

Expected outcome

The reform will remove the old somewhat unrecognised system of favouring patients who pays extra fees for doctors.

As an undesirable effect the new system may create an incentive for public hospitals to improve their economic position or attractiveness as an employer by developing vigorously these new special outpatient department services. As a result the access to care may become more, not less unequal when the special outpatient departments requiring supplementary fees become an important way for patients to get an access to hospital care and access to regular public hospital services becomes restricted.

The new system can promote the more efficient use of hospital equipment.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The impact of the policy process is strongly dependent on implementation, which can not be forecasted at this moment.

References

Author/s and/or contributors to this survey

Lauri Vuorenkoski & Ilmo Keskimäki

Empfohlene Zitierweise für diesen Online-Artikel:

Lauri Vuorenkoski & Ilmo Keskimäki. "Supplementary fee outpatient departments". Health Policy Monitor, 02/11(2004. Available at http://www.hpm.org/survey/fi/a4/2