In a reorganized U.S. Health System with UHC could there still be “cost sharing” ( patient co-pays and deductibles) to prevent excessive use of the system?
American employers and policy makers are unique in their conviction that cost sharing (co-payments) will hold down rising health care costs. As European experts note, the US has had by far the greatest amount of cost sharing for decades and by far the most costly health care system with the poorest controls over its escalating costs.*REF 1 When Congress decided that senior citizens should pay for the first day of hospitalization, what did they have in mind? -That patients whose doctors think their problem is serious enough to be hospitalized should be encouraged to refuse because of the cost? Or go hospital shopping? Or generate income for Medicare? No other advanced system considers co-pays as a serious tool for cost containment or income, and most consider them clinically perverse as well as unethical. Several have used them and then dropped them because of their administrative costs, nuisance and perverse effects on patients and staff. No evidence exists that co-pays lower the rate
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