Most people should pay for NHS drugs

BMJ 1997; 315 doi: (Published 08 November 1997) Cite this as: BMJ 1997;315:1177
  1. Linda Beechama
  1. BMJ

    NHS prescriptions should be abolished, except for people who cannot afford them or who are chronically ill.

    The proposal comes from the right wing think tank, the Institute of Economic Affairs, which argues that the present system, in which 83% of prescriptions are free and the rest cost £5.75 ($9.20) an item, is pointless and wasteful. In Should Pharmaceutical Prices be Regulated? the institute's health and welfare unit points out that each member of the population receives 9.5 prescriptions a year, covering drugs to the value of £87. Most people could easily afford such a sum, and it would be more efficient to allow them to pay.

    The book examines the different methods by which governments try to control drug prices and asks whether it is desirable that they should do so. The unit's director, David Green, says that most governments regulate drug prices because the drugs are provided through the state health system and they are usually the only purchaser.

    Several contributors criticise the method used in Britain to control drugs. Under an agreement between the Department of Health and the Association of the British Pharmaceutical Industry, which is due to be renegotiated in 1998, the pharmaceutical price regulation scheme controls the level of profits of firms that supply the NHS. The institute says that the scheme distorts the industry. By standing in the way of price flexibility it prevents suppliers from trying out different pricing strategies, and, by fixing the amounts allowed for research and development, it may constrict research if the amounts are too little or encourage waste if they are too large.

    The pharmaceutical price regulation scheme, prescription charges, and exclusion lists are used to save money for a state run healthcare system. But the book asks whether governments should limit pharmaceutical expenditure when many drug treatments were known to be cost effective. If the right drug treatments prevent or reduce the need for hospital treatment it may not be in the government's economic interests to restrict drugs.

    Should Pharmaceutical Prices be Regulated? is available from the Institute of Economic Affairs, London SW1P 3LB, price £12.

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