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

The NHS will continue to decline while tax is described as a burden

If we start from Alan Maynard [1] and accept that “a single payer, tax financed health care system like the NHS offers greater efficiency and equity” then the sensible solution is to increase tax until it pays for the NHS. It really is that simple.

Let us say that the current spend is £X, and the extra required to ensure ‘free at the point of need’ is £y, then the most efficient way is to increase tax to provide £y, and then you have £(X + y). Yes, you could find that money from some form of top-up or insurance, but that is not so efficient. The NHS then costs £(X + y + p), where p is the extra cost of administering some sort of parallel funding. Inevitably, the less well off will then get worse health care.

Steven Ford is right [2]: “Tax is not a penalty on ‘hard working families’ it is their investment in an orderly, inclusive, civil society.” Unfortunately, too many of our newspapers and too many of the present government regard tax as a ‘burden’, and too much tax is unpaid. For the NHS to survive as it is will require changes in attitude that seem unlikely.

1 http://www.bmj.com/content/355/bmj.i5424/rr-0
2 http://www.bmj.com/content/355/bmj.i5424/rr-2

Competing interests: No competing interests

17 October 2016
Neville W Goodman
Retired anaesthetist
Bristol, UK