Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
J Med Ethics. 2023 Nov 23;49(12):844-849. doi: 10.1136/jme-2022-108856.
Patients not attending their appointments without giving notice burden healthcare services. To reduce non-attendance rates, patient non-attendance fees have been introduced in various settings. Although some argue in narrow economic terms that behavioural change as a result of financial incentives is a voluntary transaction, charging patients for non-attendance remains controversial. This paper aims to investigate the controversies of implementing patient non-attendance fees.
The aim was to map out the arguments in the Norwegian public debate concerning the introduction and use of patient non-attendance fees at public outpatient clinics.
Public consultation documents (2009-2021) were thematically analysed (n=84). We used a preconceived conceptual framework based on the works of Grant to guide the analysis.
A broad range of arguments for and against patient non-attendance fees were identified, here referring to the acceptability of the fees' purpose, the voluntariness of the responses, the effects on the individual character and institutional norms and the perceived fairness and comparative effectiveness of patient non-attendance fees. Whereas the aim of motivating patients to keep their appointments to avoid poor utilisation of resources and increased waiting times was widely supported, principled and practical arguments against patient non-attendance fees were raised.
A narrow economic understanding of incentives cannot capture the breadth of arguments for and against patient non-attendance fees. Policy makers may draw on this insight when implementing similar incentive schemes. The study may also contribute to the general debate on ethics and incentives.
患者未事先通知就不参加预约，这给医疗服务带来了负担。为了降低未到诊率，在各种环境下都引入了患者未到诊收费。尽管有人从狭隘的经济角度认为，经济激励导致的行为改变是一种自愿交易，但向患者收取未到诊费用仍存在争议。本文旨在调查实施患者未到诊收费的争议。
旨在描绘挪威公共辩论中有关在公共门诊引入和使用患者未到诊收费的论点。
对公众咨询文件（2009-2021 年）进行主题分析（n=84）。我们使用了格兰特的工作为基础的预先构想的概念框架来指导分析。
确定了一系列支持和反对患者未到诊收费的论点，包括对收费目的的可接受性、对收费的自愿性、对个人特征和机构规范的影响，以及对患者未到诊收费的公平性和相对有效性的看法。虽然激励患者遵守预约以避免资源利用不足和等待时间延长的目的得到了广泛支持，但也提出了一些反对患者未到诊收费的原则性和实际性论点。
对激励措施的狭隘经济理解无法捕捉到支持和反对患者未到诊收费的论点的广度。政策制定者在实施类似激励计划时可以借鉴这一见解。该研究也可能为关于伦理和激励的一般辩论做出贡献。
