Talk:Copayment

Added
Added a section (with references) on some of the downstream effects of copayment. Would welcome discussion or other thoughts on the article as it is now. MastCell 17:07, 1 August 2006 (UTC)


 * This is an American term? The article doesn't really define it. Is it a contractual term, like an "excess" - where only costs exceeding a certain limit are covered by the policy, leaving the insured to cover the costs up to that limit?--Shtove 20:08, 24 January 2007 (UTC)


 * As far as I know, it's a concept used mostly in the American system of health insurance. I think what you're describing above would be a "deductible" - that is, if you have a $500 annual deductible, you have to cover all costs up to $500/year before the insurance kicks in. The copayment is separate - basically, every time you see the doctor, you pay $10, or $25, or $50, or whatever the copayment is. As the article suggests, the idea possibly to make people think twice about accessing the healthcare system, although may have deleterious effects (see the article refs) as it can discourage appropriate use as well as inappropriate use. MastCell 21:06, 24 January 2007 (UTC)
 * Thanks. Something similar is used in the "socialized" health care system of Ireland, where you pay up front to access the emergency facilities. Guess health care systems are pretty mind numbing in their variety.--Shtove 23:59, 24 January 2007 (UTC)


 * This is a useful entry. There are some good recent studies. The NEJM (11 October 2007, 357:1465) had a Perspective which reported how Pitney Bowes found that they were paying more for employees with copayments and chronic diseases, and when they reduced copayments, overall costs dropped. The NEJM also had 2 peer-reviewed articles, based on insurance company claims data, of corporations that increased copayments, and had worse outcomes. I'll have to look them up and add them.


 * Do the advocates of copayments have any peer-reviewed studies to support their claims? Nbauman 22:55, 24 October 2007 (UTC)

Deductible vs Copayment
I'm pretty sure that copayment is the same as an "excess" (typically a sum deducted per claim). Is there any reason to distinguish this article from Deductible? Richard Pinch (talk) 22:57, 10 June 2008 (UTC)


 * Richard, I don't know what an "excess" is -- it sounds like paying the last amount on a bill instead of the first -- but I can explain the difference between a copayment and a deductible. Imagine that you break your arm.  The initial bills total $1,000.  Every follow-up visit costs $150 (e.g., to get the cast off).  Here's the difference:
 * No copayment. Deductible is $500 per year.  You pay:  $500.   Insurance pays:  Everything else for the rest of the year.
 * Copayment is $25. No deductible.  You pay:  the first $25 per visit (and probably per prescription medication).  Insurance pays:  Everything after your $25 per visit.  If your visit costs $25 or less, then the insurance company doesn't pay anything at all.
 * If you expect to have acute medical problems that can be resolved with one or two trips to the doctor, then you will pay less under a copayment system. If, on the other hand, you have a complex problem -- brittle diabetes, starting warfarin therapy, pain requiring extended physical therapy, multiple prescription drugs -- then those copayments can easily end up costing more than a regular deductible.
 * Additionally, there's the concept of Coinsurance, which is industry-speak for the insurance company only paying part (usually 80% in the US) of the remaining bills instead of "everything". Insurance policies also combine all of the above:  You pay the first $500 (or whatever) each year, plus $25 (or whatever) for every trip to the doctor or pharmacist, plus 20% of whatever's leftover.  WhatamIdoing (talk) 07:46, 21 June 2008 (UTC)


 * "excess" is the commonly used term in the UK for a set payment of the initial part of the claim. eg. The excess on my home contents insurance is £50, so essentially I have to pay £50 to make a claim. This is partially to prevent people claiming for every possible tiny loss as it means that it isn't rational to submit a claim for less than £50.Anonymous watcher (talk) 11:53, 18 August 2011 (UTC)

Countries
Can anybody help me what countries there are copayment? I know it there is in Hungary and Czech Republic --Beyond silence 10:19, 11 January 2008 (UTC)

Other countries than USA?
I think the article as it stands describes something existing in the US, but there is no mention of the US in the article.

Does co-pay exist is any countries other than the USA? Is it called something different? 86.184.97.64 (talk) 11:47, 18 August 2011 (UTC)

I have put the words "In the United States," at the start of the article in an attempt to clarify this, but really the article needs to be rewritten with location content in the appropriate places and without US-centric assumptions. Considering I came to this article to discover what "co-pay" means I don't think I should attempt any significant edit!Anonymous watcher (talk) 12:05, 18 August 2011 (UTC)


 * Michael Moore highlighted the unethical nature of copays in his film 'sicko'. I sincerely doubt any other nation on the planet operates a system of malicious capitalism as ruthless as the US. Here's hoping you get that universal healthcare you've been needing. Or that boat to Cuba - whichever works. 89.100.48.115 (talk) 20:22, 28 July 2012 (UTC)


 * The Australian government is planning to introduce co-payments. Mitch Ames (talk) 12:08, 29 June 2014 (UTC)

Increased cost risk
The only real disadvantage the article mentions is disadvantage and risk to the consumer. However I assume there's also a risk to the company that if people avoid treatment too much for small things, they could develop more serious conditions which will end up costing the company more than money saved from people reducing treatment for non essential conditions. Do any sources discuss this? Nil Einne (talk) 09:55, 5 April 2013 (UTC)