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11 Oct 2019

BY DR CHRIS MOY, CHAIR, AMA ETHICS AND MEDICO-LEGAL COMMITTEE

The AMA’s Ethics and Medico-Legal Committee (EMLC) recently discussed whether it is ethically appropriate for a doctor to offer Afterpay (or similar) financial payment services in their medical practices.

Afterpay[i] is a payment service promoted as an alternative to credit. It charges retailers to offer customers interest-free instalment plans by splitting a purchase amount over four fortnightly instalments. The service is free to customers who pay on time, with no interest and no contracts. Unlike other payment products, Afterpay does not require customers to enter into a loan or credit facility or pay any upfront fees or interest.

Concerns have been raised that Afterpay (and similar services) derives much of its income from late payment penalties, largely driven by the fact it does not undertake credit checks and is generally used by younger people that may have limited financial literacy or capacity to pay.

The AMA contacted the Medical Board to obtain their views on doctors offering payment services such as Afterpay. In its guidance on financing schemes for doctors who provide cosmetic medical and surgical procedures, the Board states that doctors should not offer financing schemes to patients (other than credit card facilities), either directly or through a third party, such as loans, as part of the cosmetic medical or surgical services.[ii],[iii]

The Board advises, however, that patients can use ‘buy now, pay later’ services such as Afterpay, Zip Pay, Openpay and ZipMoney as accepted payment methods for cosmetic medical and surgical procedures. So long as the doctor does not promote these products to patients, they can inform patients about funding options and accepted payment methods.

There is extensive uptake of payment services such as Afterpay which are driven by consumer demand – they are convenient and easy to access, and patients may increasingly expect their doctor to offer them.

But just because patients may want such a service, is it appropriate for doctors to offer it, knowing that there could be serious financial implications for some individuals, particularly those with poor financial literacy or who are otherwise unable to meet their repayments?

While such services are similar to offering credit card facilities, these services do not have the same checks and balances during application (which is likely part of their appeal) thus making them particularly attractive for those who do not wish, or are unable, to use a credit service.

But is it really a doctor’s role to judge how a patient chooses to pay for their medical services? On the one hand the AMA is moving towards acknowledging that it is the right, and responsibility, of the community and governments to determine its positions over other ethical matters. On matters such as euthanasia and abortion, the weight of community sentiment is toward ‘let us decide’. But with choice comes the burden of consequence. Is it then reasonable for the community to place the responsibility onto doctors to have a contrasting paternalistic role on matters such as this, and to take on the burden of blame, in matters relating to the financial independence of individuals, except where a doctor is knowingly complicit in situations where vulnerable patients are taken advantage of?

Certainly financial regulators, as instruments of government and therefore the community, must have a central role here.

So what can a doctor do to support patients in making decisions involving payment of medical services?  

A doctor has a responsibility for ensuring that their patient is aware of his or her fees (which must be fair and reasonable) and for encouraging open discussion with their patients about health care costs. The doctor (or the doctor’s representative such as practice staff) must facilitate informed financial consent to ensure patients understand and consent to the potential fees for medical services (there may be exceptions in emergency situations).[iv] Where patients are concerned with their out-of-pocket costs for the medical service, they can discuss their concerns directly with their treating practitioner.[v]

And what about offering specific payment services? Doctors should not enter into an agreement with any financial service which creates a financial incentive to sell medical treatments or procedures. So long as a doctor does not use a financial service to take advantage of, coerce or induce patients to accepting treatments and procedures, the EMLC considers that a doctor should be able to decide for themselves what payment services they offer to patients.

What do you think? Send your views to ethics@ama.com.au

 

 

REFERENCES

[i] Afterpay. How it Works. https://www.afterpay.com/en-AU/how-it-works

[ii]  Medical Board of Australia. Information Sheet. Cosmetic medical and surgical procedures – guidance on financing schemes, 13 May 2019.

[iii] Medical Board of Australia. FAQs – Guidelines for Registered Medical Practitioners who perform cosmetic medical and surgical procedures https://www.medicalboard.gov.au/Codes-Guidelines-Policies/FAQ/FAQ-guidelines-for-cosmetic-procedures.aspx

[iv] AMA Position Statement on Informed Financial Consent 2015.

[v] AMA Position Statement on Setting Medical Fees and Billing Practices 2017.


Published: 11 Oct 2019