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No-show fees for hospital patients

Country: 
Denmark
Partner Institute: 
University of Southern Denmark, Odense
Survey no: 
(4)2004
Author(s): 
Mickael Bech & Mette Birk-Olsen
Health Policy Issues: 
Others, Access
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no
Featured in half-yearly report: Health Policy Developments Issue 4

Abstract

The central Government presented a bill in March 2004 suggesting that the Ministry of Health should be enabled to approve experiments with charging fines on non-attendees for hospital treatment. This bill was approved and introduced by law by the Parliament in June 2004. The purpose of this policy is to reduce patients? non-attendance rate for ambulatory appointments and appointments for operation.

Purpose of health policy or idea

The central Government presented a bill in March 2004 suggesting that the Ministry of Health should be enabled to approve experiments with charging fines on non-attendees for hospital treatment. This bill was approved and introduced by law by the Parliament in June 2004. The purpose of this policy is to reduce patients' non-attendance rate for ambulatory appointments and appointments for operation. The policy proposal allows hospitals to charge non-attending patients a fine which should influence the patients' financial incentive to miss an appointment.

Main points

Main objectives

To reduce non-attendance rate in hospitals .

Type of incentives

Patients are charged a fine which should motivate them not to miss an appointment.

Groups affected

Hospitals are going to set up an administrative system to handle fines.

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal marginal fundamental
Public Visibility very low low very high
Transferability strongly system-dependent rather system-neutral system-neutral

Political and economic background

The Minister of Interior and Health presented the bill in March 2004 as part of the governments' policy. The suggestion to enable hospitals to fine non-attending patients is part of a broader policy which should enable public service produces to fine user for misuse (parents picking their children to late etc.).

Change based on an overall national health policy statement

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no

Origins of health policy idea

The idea to fine non-attending patients has been discussed for some time. The possibility to fine misuse has been piloted in kindergarten but has not been used in hospitals. Some of the primary health care providers already are allowed to charge fines for non-attendance. Chiropractors, dentists, feet therapists, physiotherapists and psychologists are allowed to charge fines but the general impression is that they do not make use of this possibility.  However, no systematic overview of the number of non-attendance or the amount of the fines for non-attendance exits. The policy proposal is the culmination of an ongoing debate about the size of waiting lists, efficiency of hospital services and patients' non-attendance. The policy proposal is innovative in a Danish context.

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

The proposal to fine non-attending patients is suggested by the central government. The counties who own, manage and finance the hospitals do not support the policy suggestion mainly because of potential bureaucratic problems. Hospitals do not have an administrative apparatus to handle fines and this will in itself increase the administrative burden. Secondly, the counties foresee a number of unsolved issues about the patients' rights and about the practical management of a fine system. Thirdly, the Association of Counties does not believe that fines only have marginal influence on the non-attendance rate.

Influences in policy making and legislation

The policy was presented as a bill March 2004 and was approved and introduced by law in June 2004.

Adoption and implementation

The counties' negative commentary to the policy may not influence the legislation process but will undoubtedly influence the implementation of the policy because they own and manage the hospitals.

Monitoring and evaluation

No evaluation is available and no system to monitor non-attendance rates are implemented systematically.

Expected outcome

Impact of this policy

Quality of Health Care Services marginal marginal fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low very low very high

References

Sources of Information

Finansministeriet, Justitsministeriet, Beskæftigelsesministeriet, Socialministeriet, Integrationsministeriet, Indenrigs- og Sundhedsministeriet. Rapport fra arbejdsgruppen vedr. betaling ved udeblivelse fra aftaler med det offentlige. København: Finansministeriet, 2004

Author/s and/or contributors to this survey

Mickael Bech & Mette Birk-Olsen

Suggested citation for this online article

Mickael Bech & Mette Birk-Olsen. "No-show fees for hospital patients". Health Policy Monitor, 09/10/2004. Available at http://www.hpm.org/survey/dk/a4/3