Topping up NHS care

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2449 (Published 06 November 2008) Cite this as: BMJ 2008;337:a2449
  1. John Appleby, chief economist,
  2. Jo Maybin, senior researcher
  1. 1King’s Fund, London W1G 0AN
  1. j.appleby{at}kingsfund.org.uk

    Is rejected by a new report, but NHS care should not be withdrawn for those who go private

    Professor Mike Richards’ review, Improving Access to Medicines for NHS Patients, has rejected top-up fees on the grounds of equity and efficiency but has recommended that patients will be able to retain their NHS treatment and pay for drugs not sanctioned by the NHS as long as the NHS does not end up subsidising the additional privately purchased care in any way.1 Any private additions to NHS care will be permitted only when they can be delivered at a separate time and place to the patient’s NHS care—a compromise that Richards considers has “the fewest downsides.”

    He also recommends that the National Institute for Health and Clinical Excellence (NICE) should review how drugs made available near the end of life, but which do not meet its cost effectiveness criteria, could be made available. Other recommendations include negotiations with the drug industry over greater flexibility in drug pricing; greater collaboration between primary care trusts to inform their general policies and exceptional decisions on drugs not yet reviewed or rejected by NICE; and better information for patients on …

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