The inverse pay lawBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6969.1663a (Published 17 December 1994) Cite this as: BMJ 1994;309:1663
EDITOR,—I have just discovered a new medical law. The new law is called “the inverse pay law” and stands alongside and may partly explain the well recognised “inverse care law.” The new law states that the more needy a patient is and the more difficult it is to look after him or her the less one gets paid for doing so.
My practice looks after a large number of opiate misusers and people who misuse alcohol and other substances. We look after the bail hostel and homeless people in Bedford. We look after six hostels; these are refuges and rehabilitation facilities. We also look after many people with marginal lifestyles in the community. For looking after one hostel we get paid the equivalent of a clinical assistant's fee for one session, and for looking after another hostel we get paid the equivalent of half a session. For many hundreds of patients in the community and the care of the four other hostels we get paid capitation fees. Many of these patients cause a huge workload: the average consultation rate of an opiate misuser is 36 consultations a year. We have calculated that, taking into account our set running costs, we pay for looking after many of these patients rather than being paid.
The only problem about my new law is that it could disappear if ever a government that recognised that these people really needed care and was prepared to pay for it was elected. Nevertheless, I consider this eventuality remote in the extreme.