Head To Head

Could private top-up insurance help fund the NHS?

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5424 (Published 12 October 2016) Cite this as: BMJ 2016;355:i5424

Face it: we won't pay enough for health care

But why, as Ian Harmer asks (1), should “those over a relatively high income threshold – say, £60,000 p.a . – [pay] a graduated contribution per NHS usage event?” Why should the sick pay for things that – mostly – are beyond their control? Why introduce fresh bureaucracy to assess each NHS usage event? Would that be each prescription? Would an operation be an event, or would the initial consultation and the preoperative assessment be separate?

Why not just increase tax for those earning more? Harmer admits his scheme would be complex but those complexities could be used to calculate a hypothecated increase in direct income tax, rather than working out charges for each ill patient.

Sadly, these discussions are the inevitable consequence of not being prepared, as a society, to pay what we need for health care.

1 http://www.bmj.com/content/355/bmj.i5424/rr-7

Competing interests: No competing interests

20 October 2016
Neville W Goodman
Retired anaesthetist
Bristol, UK