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Top-ups for cancer drugs: can we kill the zombie for good?

BMJ 2008; 337 doi: (Published 30 June 2008) Cite this as: BMJ 2008;337:a578
  1. Cam Donaldson, director
  1. 1Institute of Health and Society, Newcastle University
  1. cam.donaldson{at}

    Fiscal pressures are prevalent throughout the world’s healthcare systems. Under such strain, it is natural to opt for “solutions” that seem to make intuitive sense. The latest innovation in this regard is top-ups for expensive cancer treatments here in the UK. Funny how politicians always look for alternative words for what are essentially “user charges.” A popular one, emanating from insurance circles, is “copayments,” and another warm and fuzzy phrase is “diversifying the revenue stream.” But they are all different forms of user charge. The question then is whether such charges are a solution to the problem at hand. This is one area of policy on which there is evidence and virtually unanimous agreement among the experts. User charges are an idea that is intellectually dead, but it keeps coming back to threaten our publicly funded healthcare systems. It has thus been classed as a policy zombie.1

    It seems powerful to say “Why not let people spend their hard-earned money in whatever way they like? Surely this relieves the public system of a burden, rather than placing one …

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