Out-of-Pocket Fee For Service: Healthcares’ Double-Edged Sword

Ashabil Rizhana

Ashabil Rizhana

Operations Manager


When was the last time your dentist told you that brushing your teeth could keep you away from their clinic? Sounds ironic, doesn't it? Well, welcome to the paradox at the heart of healthcare systems worldwide, especially the fee-for-service models predominant in developing countries.


The Cobra Effect in Healthcare

Let’s talk about cobras first. Yes, cobras. Imagine colonial India, British rulers, and streets writhing with cobras. To solve this issue, the British decide to pay for every dead cobra. Smart, right? Wrong. People started breeding cobras for bounty, and the problem worsened. This, my friend, is known as the Cobra Effect, and it has its fangs deep into our healthcare systems.


Under fee-for-service models, you'd think the goal is to make patients healthier. Ironically, the system thrives on the sick. Let’s break it down with diabetes, a condition surprisingly easy to prevent with lifestyle changes. Yet, prevention isn’t the priority because those with chronic diabetes pay more for the system's services. There’s no real incentive for preventive measures when the money flows from treating illness.


Prevention Doesn’t Bring in the Cash

Brushing your teeth daily is simpler and cheaper than a root canal, but does the healthcare system vouch for the former? Rarely. Preventative steps don’t bring in the cash. And this isn’t just about your oral hygiene. It’s the blueprint for many health conditions under such a model.


Then there’s the trust issue. When patients step into a clinic, they hope to walk out healthier. However, the system’s focus on service-based profits can sometimes sideline the patient's well-being. Corporate hospitals, driven by bottom lines, may push for unnecessary procedures because that’s what brings in the money, not the advice to eat healthier or exercise more.


A Financial Burden

The fee-for-service model doesn't just keep people sick; it also makes them poorer. For many, getting the needed procedure means draining their savings or going into debt. It's disheartening when the affordability of healthcare determines survival. Physicians, who wish to prescribe the best possible care, find themselves considering what the patient can afford, not what’s medically optimal.


This model isn’t just a story from a far-off land. It’s the reality for most developing countries across Africa and the Asian subcontinent. It’s a system where prevention is the punchline of a joke, and the health of millions is compromised for profit.


Before we part ways, I’d nudge you, gently, of course, to read "The Innovator's Prescription" by Clayton M. Christensen. It’s a bible for those of us eager to rewire the healthcare system’s circuitry for the better.

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