Charging for some treatments is justified only if NHS proves it is efficient, says public

BMJ 2013; 346 doi: (Published 16 April 2013) Cite this as: BMJ 2013;346:f2432
  1. Gareth Iacobucci
  1. 1BMJ

The UK public remains firmly supportive of the principle that healthcare should be free at the point of use but would support charging for a limited range of treatments and services in the face of growing economic pressure, new research indicates.

Detailed research by the healthcare think tank the King’s Fund and the pollster Ipsos MORI has found that most people steadfastly believe in the principle that access to healthcare should be determined by need and not people’s ability to pay.1

The report, produced after two “deliberative events” in London and Leeds designed to inform and test the public’s views on NHS funding, came after recent research from the King’s Fund showed that the United Kingdom could be spending 20% of its gross domestic product on the health service in 50 years’ time if current trends continued.2

It came as Malcolm Grant, chairman of NHS England (previously the NHS Commissioning Board) told the Financial Times that he feared future governments would have to consider introducing charges to users of some NHS services unless the economy strengthened.3

The researchers selected members of the public from across the sociodemographic and political spectrum and introduced them to a large amount of “relatively complex and unfamiliar information” to gauge its effect on their views on NHS funding. Around 40 people attended each event.

Participants said that they were opposed to means testing as a way to control future health spending in both principle and practice and strongly believed that the quality of clinical care should not be compromised to reduce costs.

But despite general reluctance to consider changes to the current funding model, some participants supported the introduction of payments for some NHS services and for charging patients in certain circumstances. This included the possibility of charging for treatments that were not perceived as clinically necessary, such as cosmetic surgery and elective caesarean sections.

There was also some support for charging people judged to be misusing NHS services, such as people who missed appointments or arrived drunk at hospital emergency departments, and those needing treatment as a result of lifestyle choices considered unhealthy, such as people who smoked or obese people.

There was strong resistance to the idea of paying to secure preferential treatment but some support for being able to pay “top ups” to non-clinical aspects of care, such as private rooms and other “hotel” type services.

But participants were clear that the NHS in its current form must be shown to be working as efficiently as possible before they would consider changes to funding. They also said that the government should tackle tax avoidance before asking the public to pay more towards the cost of care.

The King’s Fund said that the research showed an appetite among the public for more information about how the NHS was currently funded and a willingness to engage in a debate about how it should be paid for in future.

Anna Dixon, director of policy at the King’s Fund, said, “Although difficult choices lie ahead, politicians have been reluctant to discuss the future funding challenge facing the NHS. This research shows that people want to engage with these issues.

“With pressures to spend more on healthcare growing and the public finances likely to be under considerable strain for the foreseeable future, it is time for an informed public debate about how much we should spend on the NHS and how this should be funded.”

Ipsos MORI’s chief executive, Ben Page, said, “The public have always said they are willing to go to great lengths to protect current NHS services, preferring to exhaust all other options before cutting NHS spending. Whether they appreciate the scale of the financial challenge facing the NHS is another matter.”


Cite this as: BMJ 2013;346:f2432