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The ethics of patient payments

Payment ethics

When considering any issues of payment, the ethical principles of patient autonomy, beneficence, non-maleficence and fairness or justice must be considered.

Many private practitioners are faced with the recurring problem of securing payment for services rendered in practice. How does one balance the ethical and legal responsibilities when asking for payment? Not only does the HPCSA forbid payment before a service is rendered, but practically speaking, it is impossible for practitioners to predict the cost of the exact diagnosis in advance.

The HPCSA’s rules also indicate that doctors should put their patients’ health interest before questions of payment. When considering any issues of payment, the ethical principles of patient autonomy, beneficence, non-maleficence and fairness or justice must be considered.

Patient autonomy requires a doctor to respect a patient’s freedom to make their own medical treatment decisions. With regards to issues of payment, patients exercise their right to autonomy by accepting that they have to pay for their treatment according to the terms and conditions of their agreement with their doctor.

Furthermore, practitioners should always endeavour to notify patients, in advance, of the estimated cost of treatment so that they are able to make an informed decision about which medical practitioner to consult with. This is why prior knowledge of a practice’s payment policy also assists the practice in preventing delayed payments and bad debt.

The principles of fairness and justice require a doctor to treat their patients fairly and justly. Patients who cannot afford to pay for medical treatment should be treated compassionately by taking into account their personal circumstances. The Health Professions Act provides that the fee charged to patients must be reasonable and that a detailed account must be given to the patient within a reasonable period. Once there is a doctor-patient relationship in place, many ethical principles come into play and a doctor may not abandon a patient on the grounds that the latter is unable to pay for treatment without making alternative arrangements for the patient.

Author: Roxann van Rugge

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