Letters
User fees would both yield money and encourage more responsible use of NHS
Editor–Creese attacks user fees but fails to make a proper case against them in Britain, basing his arguments predominantly on evidence from countries in the second and third worlds.1 Creese's statements about the disadvantages of user fees may be true for underdeveloped nations, where absolute poverty is common and the main diseases are infections and illnesses associated with real deprivation. The situation in first world nations is different. Both the media and politicians have encouraged what is effectively a disengaging of demand from absolute need, at least as far as primary care is concerned. As a result, demand spirals upwards while real need increases little, if at all. Ham has described the situation in Singapore, where user fees are the key to reducing demand in a first world system.2 User fees are also used extensively in western European countries to reduce demand.
Creese believes that supporters of user fees are
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- Andrew Creese
BMJ 1997 315: 202-203.[Extract] [Full Text]
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