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

Re: Could private top-up insurance help fund the NHS?

Whilst David Wrigley makes a compelling ethical and moral case, the financial case for a universal health service, free at the point of use is largely absent from his argument. Goodman (1) eloquently sets out an important arm of the financial case namely that to introduce top up there has to be an additional administrative cost which given the breadth and depth of health provision can only mean introducing inefficiency to the system. This is something that has already been seen in the UK in the context of social care.

Going beyond this, I believe there is a compelling argument to apply Keynesian principles to health and take advantage of the current economic climate of low interest rates to invest in future economic productivity. Both the coalition that preceded the current administration and the labour government before that recognised this principle and explicitly invested in services for high morbidity, high mortality conditions that affected the economic productivity of young adults. The accompanying economic analysis by McCrone et al is compelling and advocates an “invest to save” approach to health (2). Given that this involves delivery of effective treatment and secondary prevention to a hard to reach demographic group, top up charges would render such an approach far less effective.

Finally, the most efficient way of spending money on health is on primary prevention and to do this requires thinking outside the notion of health, social care, welfare and education as being distinct entities. The Marmot review (3) makes this case, arguing for investment in children through provision of good quality housing, meaningful access to education and elimination of poverty to bring about improved long term health outcomes. He demonstrates that these are provisions that are unequally distributed and have become more so under the last administration. I would argue that there are no signs that the present administration is likely to reverse this. Top up charges would simply entrench a shift towards treatment rather than prevention and would do nothing to meaningfully alter public health thereby introducing further inefficiency over the long term.

1. http://www.bmj.com/content/355/bmj.i5424/rr-4
2. http://www.kingsfund.org.uk/publications/paying-price
3. http://www.instituteofhealthequity.org/projects/fair-society-healthy-liv...

Competing interests: No competing interests

18 October 2016
Michael J Shaw
Consultant in gender dysphoria
NRGDS, Benfield House, Walkergate Park, Benfield Road, Newcastle upon Tyne