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

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

Decisions not to fund some treatments under the NHS have been vigorously 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 health system

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

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

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

Fair care

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

Control on costs

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Top-up fairly according to means

Alfred P J Lake
BMJ 2008 336: 1205. [Extract] [Full Text] [PDF]

Should patients be able to pay top-up fees to receive the treatment they want? Yes

James Gubb
BMJ 2008 336: 1104. [Extract] [Full Text] [PDF]

Value based pricing for NHS drugs: an opportunity not to be missed?

Karl Claxton, Andrew Briggs, Martin J Buxton, Anthony J Culyer, Christopher McCabe, Simon Walker, and Mark J Sculpher
BMJ 2008 336: 251-254. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Klein, R. (2008). What does the future hold for the NHS at 60?. BMJ 337: a549-a549 [Full text]  
• Lees, C. C (2008). Not allowing top-up fees is unethical. BMJ 336: 1205-1205 [Full text]  
• Lake, A. P J (2008). Top-up fairly according to means. BMJ 336: 1205-1205 [Full text]  

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]