Analogy does not apply.

1. Editorial: Extra fees for uninsured services (May 2016) 2. RxFiles: Pharmacologic management of COPD. Breadth of products for encouraging a breath of air (May 2016) 3. RxFiles: Prise en charge pharmacologique de la BPCO. Un éventail de produits pour insuffler une bouffée d’air (mai 2016) 4. Clinical Review: Adult health checkup. Update on the Preventive Care Checklist Form© (April 2016) 5. Commentary: Ecology of family physicians’ research engagement (May 2016) Analogy does not apply Dr Ladouceur’s restaurant analogy in his May editorial1 is inapplicable and nonsensical. Restaurant owners set their own “fees” to cover their costs and increase them based on market forces and cost increases. A third party determines the fees for physician services and, most importantly, determines which of those services are covered. The third-party payer has no interest in educating the customer as to what is covered and leaves it to the physician to either absorb that cost or pass it on to the consumer. Furthermore, goods and services in Canada are laden with hidden costs. The advertised price has goods and services and provincial sales taxes added after the fact and, if a restaurant, gratuity is not included. It is a fact of human nature that services provided for free are devalued and become expected. Just as taking the time to explain why an antibiotic prescription is not necessary decreases re-presentations expecting antibiotics, educating patients (and employers!) on the costs of what is not covered by Medicare decreases unnecessary repeat requests that creep into the publicly funded domain. By instituting an automated recall system and charging for no-shows, our clinic has dramatically decreased no-shows and thus decreased wasted appointments and improved accessibility. Not charging (fairly) for uninsured services and not reinforcing to patients that there is a cost for not showing up for their appointments perpetuates the unsustainable delusion that Medicare should “just pay for everything.” This actually increases costs to the public purse and threatens the sustainability of publicly funded health care. —Paul V. Mackey MB BS CCFP CAC (FPA) FCFP Fort St John, BC