Why SHOULDN'T patients buy their own treatments?
By Jayne Warren - 09/05/2008
The recent ruling by NICE about the Alzheimer’s drug Aricept is one of numerous hotly disputed decisions not to fund some treatments under the NHS. And now a new debate is emerging - should patients be allowed to purchase such treatments privately rather than go without?
The issue has been debated by two experts debate on BMJ.com - who have very different opinions on the matter.
James Gubb, director of the health unit at an independent social policy think tank (Civitas), believes that the supplementation of NHS care with private treatment is already widespread, and that the practice will become more common as the finite budget of the NHS becomes less able to cover all the medical care that people want or require.
In his view, the real issue is that these “top-ups” have been ad hoc, exclusive, unnecessarily expensive, and completely at odds with the purpose of the NHS - equal access to health care based on equal need.
The answer, says Gubb, is to create an equitable framework for top-up fees affordable to all - rather than just the wealthy and articulate. This framework would then allow many more patients to benefit from a drug treatment than if they had to pay for the entire course themselves, and would protect the idea of universal health care for which the NHS stands.
Gubb calls for an insurance type of contract similar to many existing European systems. For example, in the Netherlands, people buy supplementary insurance for health care such as cosmetic surgery and more comprehensive dentistry. This has led to reduced costs, better quality health care, and fees that are affordable to the majority. In fact, 93% of the Dutch population have some form of supplementary insurance.
But Karen Bloor from the University of York, believes that assessing effectiveness against cost is the best way to determine what treatments finite amounts of NHS money should fund, and that the inevitable rationing of treatments is only acceptable if it is objective, fair, and applies to all. She claims that allowing patients to pay top-up fees will greatly reduce the fairness of health care rationing, as NHS patients with exactly the same condition would receive one treatment if they could afford to pay for it, and another if they cannot.
She also warns that when the cost of a treatment is not paid for by the NHS, a strong single purchaser, but by individuals or their insurers, there would be little pressure to keep the prices charged by drug companies down.
The solution?
Moor believes that if new treatments are judged to have some level of effectiveness but are not cost effective, drug companies should face incentives to reduce prices so that they become cost effective for use in all NHS patients, rather than just some. “Instead of allowing companies to market limited products to desperate patients, it may be better to link the price of drugs with their value.
The NHS should be maintained and improved to provide care for all patients, regardless of ability to pay”, she concludes.
Click below to view the two articles. But we'd like to know YOUR views on this controversial topic. email: editorial@maturetimes.co.uk