Paying $20 per visit, at 10 visit, it is $200 out of pocket. They have have skin in the game. This will cut down a lot of abuse. Germany had something like you

Paying $20 per visit, at 10 visit, it is $200 out of pocket. They have have skin in the game. This will cut down a lot of abuse. Germany had something like you propose from 2004 until 2012 (1). It was not particularly successful and therefore consequently abolished. (1) https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr?wprov=sfla1 https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr?wprov=sfla1