Top-up fairly according to means

doi:10.1136/bmj.a165

BMJ 2008;336:1205 (31 May), doi:10.1136/bmj.a165

Letters

Top-up fees

Top-up fairly according to means

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Many users of NHS services already top-up by paying for privatecare, which not only discriminates against those who cannotpay but also alleviates pressure for reform because these peoplewould exert the most influence.

So, how to square the circle?¹ Services could be categorisedinto three groups, which would need to be properly defined.Firstly, core services of high quality should be provided aspart of the tax funded NHS. Secondly, cost effective servicesoutside the core should still be open to all but be paid forin proportion to disposable or taxable income.² Thirdly, servicesat the margins, perhaps wanted but not needed, would be fundedby the individual in full. A body should be set up to identifycore services and set a relative value to the others.

Alfred P J Lake, consultant in anaesthesia and pain medicine

¹ Glan Clwyd Hospital, Bodelwyddan, Denbighshire LL18 5UJ

apjlake@aol.com

Competing interests: None declared.

Bloor K. Should patients be able to pay top-up fees to receive the treatment they want? No. BMJ 2008;336:1105. (17 May.)[Free Full Text]
Lake APJ. Patients should pay a percentage of income. BMA News Rev 2000; January: 30.