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Prescription charges: change overdue?

BMJ 1998; 317 doi: (Published 22 August 1998) Cite this as: BMJ 1998;317:487

Britain can learn from systems of copayments based on drugs' effectiveness

  1. T Walley, Professor of clinical pharmacology.
  1. Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 3GF

    The NHS prescription charge, currently £5.80, is not related to the cost of the medicine but is a tax for the use of NHS services, intended partly to deter excessive demand for prescriptions. Its deterrent value is currently limited: about half the population are exempt, and only 14% of prescriptions are charged for.1 The charge itself is criticised as a tax on the sick for its rate of rise and high level.2 About 60% of prescriptions cost less than the charge, and many doctors now offer private prescriptions to non-exempt patients, where this will cost less than the charge,3 or advise patients to buy some medicines over the counter.4 Non-exempt patients are less likely to get a prescription dispensed than exempt patients.5 Many anomalies exist: patients with some diseases, such as hypothyroidism, pay no charges even for unrelated medicines, while some groups, such as elderly people, are entirely exempt, irrespective of their financial circumstances.

    A recent review concluded that while patient copayments do reduce medicine use, they reduce the use of both desirable and less desirable medicines.6 Experience in Australia suggests that any such detrimental effect is short lived,7 and in the United Kingdom increases in prescription charges lead to only a slight decrease in prescriptions dispensed …

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