Paying medical bills at Kiosks in China: Is it a viable model for the USA?

Sir,

On a recent visit to the new FirstAffiliatedHospital, Wenzhou Medical College, Zhejiang, China, we were not only impressed by its bed capacity (3,250 beds) and equipment, but also by its innovative way to collect fees and provide services. Many of our conversations throughout our visit to the medical center were in regard to reimbursement.[1,2] Much to our surprise what we thought were ATM machines were, in fact, fee payment transaction systems (FPTS). Throughout the hospital there are 64 FPTS machines [Figure 1]. These devices have multiple screens that direct payments to the proper area/code for services rendered.

Figure 1.

Fee payment transaction system, First Affiliated Hospital, Wenzhou, Zhejiang, China

These machines take cash, credit cards, national hospital cards, and private insurance cards. They are used for many services. Deposits are made prior to the provision of clinical/medical, surgical, or laboratory services. The FPTS is also used for downloading medication prescriptions. Prescriptions from the “essential” list are free; a listing of government sponsored generic drugs. If a medication is imported there must be prepayment for it. Also, if the patient chooses, he/she may select the drugs for which they can afford to pay, that is, if the patient's physician has written for drugs from the imported medications list. The FPTS also prints laboratory results and is used for clinic registration and same day surgeries.

All medical insurance cards sanctioned by the government can be used. Certain services require higher levels of insurance, such as cardiac surgery. In other words, a copayment is needed. The government encourages use of local medical services before receiving care from a provincial capital (usually a larger hospital/medical center). As a patient seeks care at a larger facility, a higher a percentage of the patient's bill will be borne by the individual.

The Chinese national medical card requires no password for its use. This could present a problem if lost, but officials deny they have privacy violations to any significant degree. If the insurance card is lost, the patient can get another by presenting a driver's license or an identity card at the nearest hospital. If for some reason they do not have a health insurance card they must go the emergency department for care.

In this era of electronic media use in American medicine, there may be an opportunity in personnel savings if these types of transaction systems were in place. It would be interesting to explore the possibility. While the FPTS may be perceived to work better for the clinic system, it is within the near term realm of possibility to initiate and eventually perfect this approach in the USA for inpatient use, especially in view of the fact that US medicine is going to “bundled” payments in this upcoming era of ObamaCare.

Before dismissing this approach out of hand, a serious discourse about its possibility/probability should be pursued by the appropriate information technology resources at academic and private medical systems, government entities, as well as with the public at large.