NHS charges are a mess, say MPs
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7560.163-a (Published 20 July 2006) Cite this as: BMJ 2006;333:163Data supplement
NHS charges are a mess, say MPs
London
Andrew Cole
The House of Commons health select committee this week calls for a complete reappraisal of the system of charging for services in the England’s health service, including the possibility of scrapping prescription charges.
The current system of charging is a mess with no comprehensible underlying principles, it says in its report: "Charges have come about piecemeal, often in response to the need to raise money."
Exemptions are also full of anomalies. "The government claims the exemptions policy is based on income: those who can afford to, pay, those who cannot, do not. However, this is not the case. Many wealthy people are exempt, but many poor working people are not."
Exemptions to prescription charges, which have not been revisited in 40 years, are particularly confusing. People with diabetes requiring insulin receive free drugs for all conditions, for instance, but people who control their diabetes through diet must pay for everything.
The committee calls for monthly prescription prepayment certificates to supplement the existing annual ones that have had poor uptake. It suggests the monthly fee should be no more than the price of a single prescription. And it wants a yearly cap on prescription costs for all patients.
The committee is also concerned about the huge variation in car parking charges. Some hospitals are charging £30 (€44; $55) a day, and some cancer patients who have to visit hospital every day for their treatment may face bills of hundreds of pounds.
It proposes that car parking fees for patients who have to attend hospital every day should be scrapped. In addition, patients and visitors who attend regularly should get a season ticket, and there should be a weekly cap on parking charges for all patients.
The current charges of up to 49p a minute for incoming calls to patients with bedside phones are labelled "unacceptable." One answer would be to make greater use of mobile phones and the committee dismisses claims they cannot be used because they will interfere with medical equipment. "Patients should be able to use mobile phones in certain areas of the hospital."
The current system of charges must change, it says. But at the moment there is a woeful absence of evidence about whether charges deter some people from seeking the health care they need or simply prevent frivolous demand. "It’s known that harmful effects occur but this is completely unquantified."
The committee proposes a wide ranging review to consider the possibility of establishing a package of core services that would be free—such as prescriptions and dental care—as well as further treatments that could be charged for.
These might include charging non-emergency patients presenting at emergency departments as well as patients who miss GP and hospital appointments.
"We have got to face up to the fact that there’s going to come a time when the NHS cannot afford to provide everything for free," said committee member Dr Richard Taylor. The committee hoped this report would open up a wide debate on what "we can and can’t afford—in other words, healthcare rationing."
The report is available at www.parliament.uk/parliamentary_committees/health_committee/hcpn060710.cfm .
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