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Opinion: Missed appointment fees are a barrier to student health

The Health and Wellness Centre’s cancellation policy disadvantages students, reinforces stigma of health care access
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FARIA JAHAN/THE VARSITY
FARIA JAHAN/THE VARSITY

It is evident that U of T’s current health and wellness services need to be revitalized in order to increase availability and accessibility for students. One prominent example of the barriers students face when accessing health care is the existence of missed appointment fees.

Missed appointment fees presumably act as a deterrent for ‘no-show’ patients. This is something the university seemingly justifies on both an economic and humanitarian basis. Firstly, medical practitioners lose potential income if an appointment gets cancelled last minute, as they would be unlikely to serve another patient with such short notice. Secondly, an hour that remains unfilled is an hour that another student could have used to access scarce health care resources.

In an email to The Varsity, a U of T spokesperson wrote, “For every missed appointment or no-show, there is another student waiting for care who is not seen. Missed appointments increase wait times and demand for services – the cost is the loss of resources for other students.”

Nevertheless, missed appointment fees often deter students from seeking health care in the first place. The risk of having to pay a fee is too high, particularly because students have dynamic schedules that change with less than 48 hours notice. Additionally, the fees disadvantage students with financial barriers who may face inflexible work hours, or lack the funds to pay off these fees.

The Health and Wellness Centre’s cancellation policy states that a student or faculty member may be subject to a fee if they fail to give adequate notice — usually 48 hours — that they will miss their appointment for any reason. 15-minute appointments are subject to a $40 fine, while 30–60 minute appointments charge a $60 fine. Astonishingly, missed psychiatric appointments come with a hefty fee of $100.

Failing to pay the fee within 30 days results in a hold on a student’s ACORN or ROSI account, preventing them from accessing their transcripts.

Ontario health care facilities have begun to switch to a capitation model — the process of paying medical practitioners a set amount for each individual in their care, regardless of treatment — calling into question the university’s first point of justification.

Instead of receiving income based on the number of billable hours, some family doctors in Ontario’s health care system have started charging flat fees, regardless of whether they see a patient once or 10 times a year.

The question must be asked: where are missed appointment fees going? And who do they actually benefit?

The U of T spokesperson wrote, “Charges for students who do not show up for their appointment are used to partially compensate physicians who have held that spot for an individual and are not otherwise being paid for their time (nor are able to provide care to other students).”

What is especially infuriating about missed appointment fees is that they impact students who are already physically or mentally vulnerable. In the case of psychiatry, these may include students whose mental health challenges have prevented them from walking 25 minutes across campus in a blizzard to reach their 9:00 am appointment, or who are in the midst of a panic attack because they are backed up on all their other appointments and deadlines.

Additionally, putting a 30 day time-limit on paying off the fees is inequitable. Students often live paycheck to paycheck because of their debt burden — or rely on their dwindling Ontario Student Assistance Plan funds to stretch until the end of the school year. Being unable to scrounge up an extra $100 within a month may require an unwell student to go without a few meals or miss an event they were saving up for. Furthermore, this will likely exacerbate the feelings of unwellness that the student originally faced.

Missed appointment fees are simply an extra punishment for students who already suffer concurrent consequences. Missing an appointment means having to rebook the appointment, which, in my experience, means having to wait another several weeks to seek health care. This is punishment in itself, and almost no student would willfully subject themselves to enduring those long wait times again. Thus, if a student misses an appointment, it is potentially for a reason outside of their control.

U of T must rethink its cancellation policy, and either subsidize or completely eliminate missed appointment fees. This would reduce the cost, as well as the stigma, of seeking proper health care as a student. In part, the accessibility of U of T’s health services acts to exacerbate the mental health crisis on campus — U of T needs to do better.

Haya Sardar is a third-year Economics student at Victoria College.