At the Friendship Hospital, the new fee is meant to plug this gap.

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These can take many forms, but often resemble a sort of health-care version of the franchise arrangements common in other industries: The leading center shares clinical protocols and advice, and the local hospital, which typically pays a fee, can publicize the relationship to prospective patients.

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Its staff of three includes a vision technician who examines patients and also arranges consultations with doctors at the base hospital via videoconference--all for a fee of less than 50 cents, which is good for three visits.

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An elder care clinic and hospital could be compensated with a per-patient fee that would cap the total cost.

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FINCA, a microlender in Uganda, runs a pilot scheme allowing members free treatment for a range of problems at a mission hospital in Kampala, in return for a small quarterly fee.

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There are the surgeon's fee, the operating room charge, equipment and supplies, the hospital bed during recovery, and other costs.

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While hospital care does carry significant copays and deductibles, the vast majority of beneficiaries (about 88 percent of fee-for-service Medicare beneficiaries) have supplemental coverage of some kind (mainly Medigap, retiree plans, or Medicaid) to cover hospital copayments.

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