Should patients be able to pay top-up fees to receive the treatment they want? No

doi:10.1136/bmj.39563.493218.AD

BMJ 2008;336:1105 (17 May), doi:10.1136/bmj.39563.493218.AD (published 6 May 2008)

Head to Head

Should patients be able to pay top-up fees to receive the treatment they want? No

Karen Bloor, researcher

¹ Department of Health Sciences, University of York, York YO10 5DD

keb3@york.ac.uk

Decisions not to fund some treatments under the NHS have beenvigorously contested. James Gubb (doi: 10.1136/bmj.39563.453183.AD)argues that patients should be able to buy such treatments privately,but Karen Bloor believes this will undermine the whole healthsystem

The first 150 words of the full text of this article appear below.

Top-up fees in the National Health Service may sound harmless—surelyif patients pay the additional cost of treatments not availableon the NHS, they benefit without causing anyone else harm? Butexplored more carefully this simply is not the case.

Firstly, treatment within a publicly funded NHS should not providewhat patients want, but what they need. Need for a treatmentimplies capacity to benefit from that treatment,¹ which meansthat the treatment must be effective. Within scarce NHS resources,there is also a requirement for treatments to be cost effectiveand to provide value for money, and it is this requirement thatcreates the rationing problem in health care. Treatments thatoffer a relatively small benefit or a low probability of benefitmay be worthwhile to an individual, but collectively they havean opportunity cost, in terms of other uses of NHS resources,that is too high.

Although individually . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Increasing NHS consumerism: Peter W Ward
bmj.com, 15 May 2008 [Full text]
Top up fees - Acceptable in education but not in health!: Nagappan Kumar
bmj.com, 18 May 2008 [Full text]
Not allowing top up is unethical: Christoph C Lees
bmj.com, 20 May 2008 [Full text]
Top-up fairly according to means: Alfred P J Lake
bmj.com, 21 May 2008 [Full text]
Top-up Fees, Privatization, and Market Driven Health Care: Elizabeth McGibbon
bmj.com, 5 Jun 2008 [Full text]
Barbed-wire and Watchtowers ?: L Sam Lewis
bmj.com, 10 Jun 2008 [Full text]
Top up fees already exist: Hendrik J Beerstecher
bmj.com, 22 Jun 2008 [Full text]