UK health care is not free at the point of delivery

“Top-up" health payments – extra private payments to supplement care provided by the National Health Service (NHS) – are now common across UK healthcare, according to a new report by Doctors for Reform.

The authors, three practising NHS doctors, are urging politicians to join with the medical profession in a national debate on the future funding of healthcare covering both tax and independent financing.

Among the author's key findings:

  • UK healthcare is not free at the point of delivery; patients are developing sophisticated approaches to purchasing upgrades to their care.

  • These "top-up" payments are occurring because of the varying limits of the NHS care package in different localities; the limits on NHS quality, including waiting times, delays and service access and the reduction in costs of some private treatments due to advances in technology and the development of a competitive marketplace.

  • Without reform to health funding, top-up payments are likely to increase due to the upward pressure on medical costs, the limits to tax-financing and most importantly, the increasing importance of consumer choice.

    NHS provision of care is inequitable but so is the current system of ad hoc "top-up" payments. There is a real risk of achieving the worst of all worlds: inequitable NHS provision combined with inequitable provision outside of the service. In both worlds the least well-off are disadvantaged.

    "The current debate on healthcare funding is strikingly inadequate. Having to 'top-up' NHS care is a reality for many patients. But the political debate continues to perpetuate the mirage of a service completely free at the point of delivery," says Karol Sikora, Professor of Cancer Medicine, and an author of the report.

    Source: UK healthcare is not "free at the point of delivery,” Doctors for Reform, April 23, 2007.

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    FMF Policy Bulletin/ 02 May 2007
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