General Health

SLIDING SCALE FEES : Countries where applicable and impact

Sliding fee scale guidelines

What Does Sliding scale fees Mean?

Sliding scale fees is a type of flexible pricing structure used by product and service providers that are designed to suit the financial capability of the client or customer. This type of pricing model is mostly adopted by legal and medical establishments.

In health care, medical practitioners or clinics who use this system charge their patients based on how much they earn and can afford. This allows low or fixed income earners to have easy access to quality medical care.

Countries such as the United States, Mexico, Canada, and the United Kingdom have provision for sliding scale fee therapy and have a number of clinics and health care professionals who practice this mode of billing.



Hospitals and medical practitioners usually prepare a single sliding scale that is applicable to all their patients. There are two ends to the scale, the minimum fee and the standard fee and the treatment fee cuts across both ends.

Simply put, patients who have financial problems and unique circumstances will pay less than the standard fee but not below the minimum fee, and those who are not financially incapacitated will be charged at a higher rate or asked to pay the standard fee.

The sliding scale fee calculator is also subject to changes as a patient’s income decreases or increases. This pricing model can be established without insurance, which means patients who are not covered by insurance can also benefit from the scale by paying directly.

In the United States, the amount to be paid based on the patient’s income is mostly in line with the Federal poverty guidelines. The National Health Service corps recommends that poverty guidelines should be used in setting up sliding scale fees.

Patients who fall below or are at the 100% mark of the Federal poverty level (FPL) will be billed to pay the predetermined minimum fee, while those above the 100% mark will pay incrementally to the point of the standard fee.

The process usually involves paper works, photo identification and documents such as tax returns or pay stubs to verify the income of the patient. The application process and rules are unique to each medical practitioner or clinic but it is pertinent that an official agreement is reached between the medical service provider and the patient.



In a society where healthcare is monetized and guided by so many financial policies, getting quality medical care may prove to be a challenge for the poor or the low-income earner and their families. Although the sliding scale model of pricing is not a complete charitable venture, it gives equal health opportunities to everyone regardless of social or financial status. A number of therapists and mental health professionals also adopt this pricing system to assist people seeking therapy in countries where mental health is not covered or is partly supported by insurance.

The sliding scale fees help to reduce the health crisis in society by narrowing the number of people left untreated due to financial constraints. A person with health issues who cannot afford quality medical care will undoubtedly resort to self-treatment which may cause more complications or even result in death.

There is also the possibility of such a person being affected by a contagious disease and posing a risk to the society at large. In essence, having access to quality and affordable medical care through sliding scale fees can impede disease outbreak.

Giving discounted rates to low-income earners will seem unprofitable but it is in fact economical. In economics, exorbitant prices do not always translate to higher gains as it may dissuade potential clients or customers from patronizing that particular service or product.

With sliding scale prices, there is the advantage of expanding the customer base to all income ranges while gaining profit from clients who can afford to pay the standard fees.

This is called striking a balance. In addition to this, the clinic or medical practitioner stands a chance of gaining a good reputation which gives them an added advantage of retaining patients and gaining more referrals from the low and high-income earners alike. on the flip side, the reverse may occur as some people tend to equate a higher price with better quality. Offering cheap prices for services may drive people to look elsewhere.

Dealing with insurance companies can be quiet a hassle for medical care providers, not with some insurance companies demanding financial requirements that mostly entail a tiring amount of paperwork.

They may also refuse to support some treatment plans or cover just a tiny percentage of the fees. However, with sliding scale fees, medical care providers can dissociate themselves from insurance-related problems.

A closer look at sliding scale fee dynamics

As with all systems, sliding scale fees is not without its faults.  Some experts are of the opinion that this system of pricing is discriminatory and unfair to those who have to pay higher prices or the standard fees for the same services being rendered.

It is also feared that some service providers may charge the high-income earners outrageous prices to favor the less privileged in the name of being benevolent or to regain profit lost from the discounted fees.

There is also the problem of work overload and reduced quality of services. For instance, a clinic that offers sliding scale fees may have an influx of patients looking to be treated at cost-effective prices, which makes for more working hours and people to treat.

If such a clinic is not well equipped to handle a large population of patients, the goal of providing quality health care will be defeated.

There is no doubt that the positive impact of sliding scale fees far outweighs the disadvantages which infers that the system should be given a fair chance to thrive. A functional and well-regulated sliding scale system will go a long way in solving existing health care problems that are largely financially motivated.


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