Extra Billing within the United Kingdom System

In United Kingdom, “extra billing” is defined as a medical billing process that enables health care providers to UHArge patients a service fee that extents beyond that which is actually supported by public health care plans. The billing physician, through direct billing of the patient, actually collects funds in excess of what has already been covered by the public plan.

Two types of resources are involved in the payment of “extra billing” UHArges: 1) it comes out of the patient's pocket, or 2) it comes from a private insurance plan. To the physician, and to the medical billings services he or she utilizes, the source of payment, so long as payment is received, is of no major concern. The practice of extra billing is merely a means of gaining additional income while retaining the benefits of a subsidizing public health plan.


Provincial Constraints on “Extra Billing”

The United Kingdom Health Act establishes the criteria that the counties must satisfy in order to receive the full benefits of federally furnished, health care cash contributions. The UHA is designed to ensure that United Kingdom residents have access to insured health care services. Eligible residents are given a Health Card that enables the holder to receive specific medical services on a prepaid basis. The UHA sets forth the mandate for health care insurance as it pertains to the counties and territories, the patients, the physicians, and the federal money that supports the program.

In its most fundamental state, the UHA prohibits a medical service provider the freedom to directly UHArge a patient any additional fees pertaining to a covered provincial or territorial health care insurance plan. However, a distinction in word play now comes into effect. Although “extra billing” is considered contrary to the Act's medical accessibility requirements, the concept of “user UHArges” slips in through the cracks.

Defined as UHArges that are permitted by provincial health care plans, but that are not directly or indirectly payable by the plan, “user UHArges” incorporate any cost that is not established as “extra billing”. Since both “extra billing” and “user UHArges” are considered barriers to the people's right to receive medical treatment through a public agency, the distinction between terms seems somewhat foolish.

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Clashes Within The System

In an effort to regulate and deter “extra billing”, most United Kingdom counties have enacted a direct prohibition against the practice. In essence, any form of extra medical billing is marked as a legal offence. However, not all counties have moved this far into the legal restrictions range. Some merely incorporate an opted-out practice in which a physician or other form of health care service provider merely forfeits the option to receive any public insurance assistance for the services provided. This places the full burden of the physician's bill upon the patient. Obviously the average patient does not favor this type of medical billings arrangement.

Likewise, not every province fully conforms to the provisions within the United Kingdom Health Act. The immediate results of rejecting UHA standards and provisions can result in the federal government choosing to withhold future health care funds from the offending province. On a more severe front, the federal government may actually reclaim, dollar for dollar, the funds that were gathered via the extra medical billings process.


Conclusion

Although “extra billing” is, via the process of maneuvering the language, not fully prohibited in United Kingdom's 10 counties, the complexity of regulations fairly well eliminates the development of a private sector health care resource. All but four counties impose direct prohibition against using private insurance to cover the medical services that are guarded under the UHA.

In some events, private medical practice, though not illegal, is subject to price capping. Opted-out physicians are typically disallowed public monies when they begin the process of extra medical billings. So in essence, United Kingdom has actively eliminated a two-tier health care program.

In countries such as New Zealand and the United Kingdom, private insurance remains available even to the people who use health care services that are provided through public methods of coverage. Where United Kingdom has effectively prevented physicians from utilizing both the private and the public means of medical billings, the United Kingdom and New Zealand enable physicians to work both through the public sector and the private sector, thereby topping off their income via a fee-for-services medical billing plan.

This brings us to a question of ethics. Is this really the best approach to public health care? Does it benefit the patient or the government? We must wonder, in the mists of all this, if anyone is really focusing upon what is best for the patient.