Should doctors charge doctors for medical services?

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6965.1318 (Published 19 November 1994) Cite this as: BMJ 1994;309:1318
  1. A Kenney

    Traditionally, doctors seeing other doctors, their wives, or their dependent children as private patients have charged no fee. Charging between professional colleagues has been regarded as undignified, unpleasant, and unseemly.

    In the days before comprehensive insurance, charges to patients were an appreciable burden, which doctors were reluctant to inflicit on their colleagues. The lack of a charge cements relationships and shows that the medical profession, unlike some other professions, refuses to bow to outside pressure to make it more financially aware and money driven. There is, however, increasing pressure to change this practice - not from doctors providing services, who enjoy the warm professional feeling derived from not charging colleagues, but from the doctor-patients themselves.

    This change has probably occurred because more doctors and their families are insured to cover the cost of private treatment. The policies negotiated by the BMA with the major medical insurers for doctors are at special rates. One types of policy assumes that no fee will be charged by the providing doctor and is designed to cover only hospital fees. The other type, designed to cover both medical and hospital fees, is more expensive but still cheaper than similar policies sold to the public. This more comprehensive policy is increasingly popular. Altogether some 20 000 medical practitioners in Britain, a fifth of the profession, now have private medical insurance.1

    The intensity of reluctance to charge may vary according to whether the doctor-patient is an immediate colleague working in the same area or a more distant colleague who is working, or has worked, so far away that there is never likely to be, or to have been, any sharing of responsibility for patients. Indeed, the doctor-patient may be from abroad. Another factor is that the charge for a routine check up, for example, may not be refundable through an insurance policy, although many doctors express the view that they are too embarrassed to return for such check ups if there is no change at all. The insurance companies would prefer doctors not to charge each other, and their favourable premiums for doctors are based on the assumption that they do not. At one time they would help to finance a gift for the providing doctor, but this is no longer allowed by the income tax inspectors.

    Perhaps a way forward is for doctors to continue to avoid charging other doctors and their immediate families unless specifically instructed to do so by the patient. If such an instruction is given, then for routine check ups not covered by medical insurance a small fee could be charged to cover administrative and practice expenses. For items covered by insurance policies the standard insurance company charge could be made. If this becomes standard practice, insurance companies might have to adjust their premiums accordingly and treat doctor-patients in the same way as members of the general public.


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