Letters Top-up fees

Not allowing top-up fees is unethical

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.a164 (Published 29 May 2008) Cite this as: BMJ 2008;336:1205
  1. Christoph C Lees, NHS consultant
  1. 1Cambridge CB2 2QQ
  1. cclees{at}compuserve.com

    Bloor bases the argument against top-up fees on fairness, particularly the desire not to allow the wealthiest automatic access to the best drugs, while those who cannot pay for private care are disenfranchised.1 The flaw in this argument is that the wealthiest already access their own treatment, often exclusively in the private sector. It is poorer patients who get caught in the “trap” of potentially being disallowed NHS care if they pay for so much as one course of treatment with a top-up drug. The greatest iniquity and inequity is surely to disallow citizens and taxpayers their NHS entitlement in the name of fairness.

    These mechanical socialist arguments are propagated through a belief that people should be in charge of their own destiny but must accept what the state gives them. It is more important to be equal than be allowed to extend the quantity or quality of life. This is some 70 years behind modern political thinking in a consumerist society, where individuals are and should be in control of their bodies and destinies.

    Ironically, I can find nothing in NHS legislation that disallows top-up payments, nor are top-up fees against the founding principle of the NHS. The secretary of state for health would be allowed to enable charges for certain drugs—if he so wished.


    • Competing interests: CCL is a founder member of Doctors for Reform.


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