Health Copagus in Italy

As you know, Italians will have to pay 10 euros for each visit to a specialist doctor, and 25 euros for emergency services that are not serious.

In several EU countries there is already some form of health co -payment so I think it will arrive in Spain shortly.It is a controversial issue, nothing new by the way, but the economic situation that the country is going through I think it will make it inevitable.

As diabetics, and users "abusive " of the SS (yes, yes, you are not surprised yet swarm among us, not in the forum, matizo, neanderthales already talluditos who wonder why the hells have to paySS if they don't use it.

Clear example of paying fair for sinners.It is very true that most people who are in the health center or in medical centers are there to touch the eggs, and these stories end up in this ......

I declare myself totally against , it is a savage.With the times that run ... I would not surprise me anything that arrived soon in Spain.

I add some other data on the copayment in Europe:

Germany.10 euros is paid the quarter without limits of outpatient consultations.
Belgica and France use a payment system in advance and reimbursement of 80% of the cost.

In Portugal, 2.20 euros are paid for visiting the health center and 4.5 for the specialist.The emergency rate is 8.40 and every day hospitalized costs 5.2
Pregnant women, children under 12 are exempt, the elderly and unemployed

In the Netherlands it is paid with a mandatory insurance system whose most basic package is 92 leuros/month.
There are lower income aids.

From what I know, in Valencia there is already a study done on the implementation and impact of the copayment.They say, according to which mentisers, that after the general elections a deterrence of the use of health services will be launched, it seems that the cost will be adapted by income sections.

Let's not say anything about Catalonia, where week and week are also with cuts.

Of course, I do not hear or see any type of mobilization against the mismanagement of the leaders, of the null human resources policies, of the null prevention policies, of the non -existent health education policies, of the disastrous thatIt is the famous remuneration for productivity or detail that are unions ...

Paganinis the usual.

I post a last article that seems interesting to me,

Copay in preventive activities affects the most disadvantaged classes
The Trivedi study published in January at the New England Journal of Medicine deals with the topic of copayment as a mechanism for the rationalization of the use of health services.

Specifically, he analyzed how the copayment affects access to mammography in a group of women (between 65 and 69 years of age).

For this, huge databases (increasingly common methodology) with data between 2001 and 2004. 366,475 women (550,082 individual observations based on a quality standard for mammography called Hedis), which were divided into two groups were included.The group with complete coverage (that is, they did not have to pay anything in their pocket to make the mammography or less than $ 10 which is approximately 10% of the cost of a mammogram) and the copayment group (which I had to pay moreof 10 dollars to get a mammogram).

Both groups were similar in characteristics except that black women and those who lived in poorer neighborhoods abounded more in insurance that demanded "copayment" that in the USA are usually cheaper (they used the postal code to estimate the socioeconomic level of patients).

In the case of co -payment systems in 2004, 69.3% of women of that age were made mammography.In the case of systems without copayment the percentage was higher (of 75.3%).

Keep in mind that the ideal percentage would be 100%, since mammogram is a cost-effective screening at that age.

Some factors related independently to the probability of not accessing mammography:

- The copayment (-7.2% estimated)
- Live in poor neighborhoods (-3.9%)
-Low studies level (-4.8%) and a half (-2.5%)

In addition, in the case of copayment systems, it does not affect the same as rich (-5.4%) than poor (-8.4%), or people with higher studies (-4.6%) just like people without studies (-12.3%), nor to blacks (-4.3%) than to whites (-7.8%).

Comments:

The copayment system is frequently defended by many (patients, doctors and political) as the solution to saturation and abuse of health systems.

A priori seems a good solution and in fact this study shows that the co -payment decreases the use of health services.

But the truth is that co -payment systems do not affect all people equally.In this case, as in many others, we are faced with one of the foundational principles of primary care: the Law of Inverse Care.

First described by Hart, a Rural Doctor of Wales in 1971 in the Lancet, the Inverse Care Law says that those who most need health services are the ones who receive the least health services.One of the tasks of primary care is to reverse this principle as much as possible.

The co -payment worsens the phenomenon of inverse care since it affects the lower classes (economically and educationally).

The accompanying editorial to the article expresses it in a clear way.The copayment system has as a premise that individuals (users instead of patients) are capable of making rational and informed decisions when consuming health services.

The existence of this premise (which the buyer makes rational and informed decisions in search of its maximum benefit) is the basis of any free market system.

Unfortunately, in the case of health services, and especially in the case of preventive activities, this premise is not fulfilled.

Although mammography is a test that is clearly beneficial and cost-effective and despite the fact that women are clearly informed about their benefits and utility, the introduction of the copag decreases the use of mammograms, and what is more important,He does it more in poor women and without studies.