Create and standardize tiers of care based on acceptable alternatives, allowing for a variety of standards of care (see 7.8 Providing Care for Those Unable or Unwilling to Pay). In this scenario, for example, a level one, minimal care standard could be considered ethical and legally defensible for financially stressed households.

       Create a system by which individuals may be “income qualified” for lower cost services, thereby assessing affordability concerns more objectively. This qualification could provide a more practical, verifiable route for justification of a minimal standard of care.

       Provide practical instruction for students at veterinary teaching hospitals to address affordability issues by advancing a breadth of diagnostic and treatment options. This may serve to address stigma surrounding reduced standards of care so that all practices, including secondary and tertiary care practices, can more readily offer a wider variety of care options (see 2.2 The Role of Incremental Care).

       Provide practice management consultation services to low‐income practices and promote the concept of for‐profit community clinics to veterinarians with shelter medicine interests or public service leanings.

       Establish not‐for‐profit payment plan services to help those with low credit scores to finance care.

       Negotiate more aggressively with veterinary pharmaceutical companies to provide lower cost drugs and products to prequalified low‐income pet owners or in shelter settings.

       Only in very specific situations will discounting be a suitable solution (see 2.11 Discounting in Veterinary Practice)

       Support and promote shelter medicine and public policy programs in veterinary schools. Establish tuition reimbursement programs for students willing to practice in low‐income settings to help address these candidates' unique financial concerns.

       Pet owners are finding it difficult to pay for the more expensive veterinary services offered by an increasingly sophisticated veterinary profession, leading to what industry analysts have described as an affordability crisis.

       National economic trends toward growing income inequality and the dearth of low‐cost options for veterinary care are at odds with the increasingly widespread cultural conception of pets as family members, further inflaming affordability concerns.

       Veterinarians' drive to increase standards of care, coupled with the higher cost of drugs, supplies and education, among other factors, have led to the higher priced veterinary services pet owners are increasingly unable to afford.

       Current solutions to the affordability problem primarily include pet health insurance, wellness plans, and financial services (credit cards and payment plans) along with a limited number of privately and publicly funded low‐cost veterinary service programs and practices.

       The future of veterinary affordability rests in the hands of the veterinary establishment, where a serious examination of affordability issues is currently under way.

      1 1 Volk, J.O. (2011). Executive summary of the Bayer veterinary care usage study. JAVMA 238 (10): 1275–1282.

      1 ASPCA press release. Miami‐Dade County Becomes 10th Community in ASPCA Partnership. (2010). www.aspca.org/about‐us/press‐releases/miami‐dade‐county‐becomes‐10th‐community‐aspca‐partnership

      2 University of Florida College of Veterinary Medicine press release. New UF and Miami‐Dade County collaboration will help homeless animals. (2016). www.vetmed.ufl.edu/2016/08/18/new‐uf‐and‐miami‐dade‐county‐collaboration‐will‐help‐homeless‐animals

      3 Sullivant, A., Mackin, A.J., and Morse, D. (2020). Strategies to improve case outcome when referral is not affordable. J Vet Med Educ 47: 356–364.