Doesn’t the drastic rise in prescription charges undermine the NHS?


by Guest    
3:05 pm - April 18th 2012

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contribution by Sirena Bergman

The decision last week to raise the cost of prescriptions by 25p follows a 20p increase last year, raising the cost of every prescription to £7.65. The move is strongly opposed by the British Medical Association (BMA) which has been campaigning for prescription costs to be scrapped altogether.

In response to last year’s price increase, the BMA wrote that: “The principle of charging for prescriptions runs counter to the founding principle of an NHS that is free at the point of use.”

Although many patients (such as pensioners and students) are exempt from paying for their prescripted medication, the fact that the NHS charges for it at all perhaps questions the essence of the NHS.

The BMA says the cost of administering prescription charges is so high that the NHS would be better off abolishing them, as current exemption rules can be confusing and unfair.

Neal Patel, a spokesperson for the Royal Pharmaceutical Society said: “Many patients have trouble affording prescriptions, which are getting more expensive every year. The most concerning question a pharmacist can be asked by a patient is ‘which item on this prescription can I do without?’ because they just can’t stump up the cash for them all.”

National health services in Wales, Northern Ireland and Scotland have already eliminated prescription costs but the Department of Health maintains that the revenue from the charge in England is too valuable to be lost at this point of economic difficulty.

The introduction of prescription charges in 1951 caused the resignation of many ministers, but the price was nevertheless set at one shilling per prescription. In 1979, the Thatcher government raised the price from 20p to 45p, which set the ball rolling.

Between then and 2001 the prices rose solidly every year and in that same time frame the number of Britons relying on private healthcare almost trebled.

US healthcare has been criticised at length, and in the UK we love to wave our Union Jacks and sing the praises of our system, which ostensibly affords free medical treatment to anyone who needs it.

This is not a privilege – it is our right and we should be grateful to live in a country which upholds the value of health over and above any financial gain.

Sadly it seems that the subtler political decisions to turn healthcare into an industry go largely unnoticed as the public fumes about the price of alcohol and the VAT on sausage rolls.


Sirena Bergman blogs here more regularly. She is also on Twitter.

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Reader comments


I suspect ” We ain’t seen nuthin yet”

Of course prescription charges only apply in England they have been abolished in Scotland and in Wales

3. Chaise Guevara

A 25p rise is hardly “drastic”. It looks routine, if anything. Similarly, a standardised charge levied on all patients deemed able to pay, regardless of the actual price of the medication, does not turn the system into an “industry”.

As for whether charges themselves are a good thing… probably not, but they presumably have some benefit in discouraging patients from taking drugs they don’t really need, or stocking up on more than they’ll get through.

I heard that the charges raise £500m for the Exchecker in a recent Medical Matters broadcast on Radio4. That ain’t chicken feed and is bound to make the government resist any efforts to reduce the charge.

There are some weird anomalies for people with chronic conditions requiring repeat prescriptions, some of which are exempt from charges and others that apparently arbitrarily are not. This at least needs to be changed.

I always hurt a bit when I pay for a prescription. I feel the same when I see the dentist because I grew up with everything free. I suppose I’ve gone along with it so far because I can afford to, but they cannot keep putting the costs up without at some point asking too much.

If the charges are not removed for people like me then they could be moderated and the anomalies removed.

These prescription charges undermine the very purpose of the NHS. I think the really dangerous thing for the Government is that, if they go ahead, Nye Bevan will almost certainly resign.

This is like that RealTimeWW2 thing on Twitter. Can we have a piece on the groundnut scandal next? Heads at the Colonial Office must roll!

6. Chaise Guevara

@ Cherub

I for one would like to see them reassessed based on importance – do people have to pay for antibiotics, for instance? Can’t remember (because every time I’ve gotten them I’ve been stressed and spaced out by an infection, hence antibiotics). And I think seperate drugs used to treat one disease should be gathered into a single prescription. Until recently I had three different drugs for one allergy, making my prescriptions more than £20. I can afford that, but some people not entitled to freebies might struggle.

Then we have the arbitrary way that you can get twice as many drugs for the same price if the doctor decides to write a prescription for a larger quantity – and if you’re on a course that has dangerous/black-marketable drugs that have to be sold in small doses, that can add up.

Finally (and trivially), an appeal to GPs: if the treatment you’ve prescribed can be bought over the counter for less that the price of a prescription, TELL ME THAT.

The only good thing about prescriptions in England is that birth control remains free.

@Chaise

25p on each medication adds up. I know people on the bread line who have to budget to the last pound, and for them they are having to prioritise what ailment they deal with. I delayed seeing my doctor whilst at university because I couldn’t afford the prescriptions, I’m sure I’m not alone. Don’t forget these rises are accompanied with rises in bus fares, food costs and stagnated wages.

Charging for spectacles and dentures was the thin end of the wedge and until we correct that wrong, the system will be flawed in principle. Also the disparity between England and the rest of the UK is also unfair.

@6 Chaise

If you’re not exempt you’ll pay, whatever the meds.

If it seems likely then I ask my friendly pharacist if it would be cheaper to buy a drug OTC and chuck the scrip. It sometimes saves money. Happily my GP is pretty good about this too.

You’re point about exempting some things on public health grounds makes sense.

10. James from Durham

For those on repeat prescriptions, you can buy a prescription prpeayment certificate for a period and this may be cheaper than paying individually. Sort of like a season ticket.

11. Planeshift

” probably not, but they presumably have some benefit in discouraging patients from taking drugs they don’t really need, or stocking up on more than they’ll get through.”

The opposite though is people on low incomes, but who don’t qualify for the free prescriptions, tend to avoid seeking treatment or only taking a few of what they have been prescribed. Or end up not completing a course of treatment once initial symptoms improve so they have spares in the cupboard for the future (and hence self-diagnosis). The net result is people don’t manage condition properly and this results in more hospital admissions. When you combine this downside with the additional cost of a means tested system for some patients recieving free prescriptions, it isn’t really clear that prescription charges in the form that england has them is sensible economics let alone sensible health care.

Part of the justification in Wales and Scotland was that abolishing charges was a policy that would pay for itself over the long run. Its probably too soon to have a full analysis of this in Wales (you’ll need decades really), but from a cost perspective the actual amount spent in Wales has only increased by about 10 mill IIRC – which in the context of health inflation and a health budget of over 5 billion is frankly irrelevant compared to the financial benefit people have had from it. In a (relatively) low wage economy with high levels of chronic conditions, it is even more rational to simply help people manage these condtions and thus stay in work…

The rational behind charges is that you need to deter people from grabbing the freebies by using a price mechanism to ration the service. But this ignores the fact that GPs still act as gatekeepers by (in theory) only prescribing what people need. Plus most prescription drugs aren’t exactly things most people want to consume – they are necessities not luxuries and many of them have unpleasent side effects. In Wales we simply did not see an army of hypocondriacs pushing the budget to breaking point when charges were abolished.

12. Chaise Guevara

@ 8 Janvier

“25p on each medication adds up. I know people on the bread line who have to budget to the last pound, and for them they are having to prioritise what ailment they deal with. ”

Agreed. I’m not saying this is a good thing.

13. Chaise Guevara

@ 9 Cherub

Yeah, I’ll check prices too, either with the GP or the chemist, but only now I’ve been alerted to it.

14. Chaise Guevara

@ 11 Planeshift

“The opposite though is people on low incomes, but who don’t qualify for the free prescriptions, tend to avoid seeking treatment or only taking a few of what they have been prescribed. ”

Absolutely – I’m just saying that there are plusses and minuses to be factored in. Likewise we could probably cut the oversubscription of many GP surgeries at a stroke by charging £5 per appointment, or £5 per appointment after X per year – but that would come at a similar price to the one described by you RE prescriptions.

If you offer people something for free, inevitably some people will take more than they need, and/or squander what they get. Tragedy of the commons. If you charge for something vital, inevitably some people will be discouraged or downright unable to take what they need. For the record, I sit very much on the side that favours higher taxes and less human misery.

Much though I think prescriptions should be free to all, surely these are only roughly inflationary rises? Of course whether people’s incomes are keeping up with inflation is another thing.

16. Churm Rincewind

@ 11 Planeshift and 14 Chaise Guevara:

“The opposite though is people on low incomes, but who don’t qualify for the free prescriptions, tend to avoid seeking treatment or only taking a few of what they have been prescribed.”

Do you have any evidence for that assertion? If someone has sought medical advice and subsquently paid for a course of prescription drugs, I can’t see why income level would be a determining factor in their decision whether to self-administer the complete course. Or is your suggestion that people on low incomes tend not to redeem prescriptions because of pharmacy costs?

17. Chaise Guevara

@ 16 Rincewind

That’s not what he’s saying. He’s saying they won’t redeem the prescriptions (or more likely won’t go to the GP at all), or that if they already have drugs for an ongoing condition, will only take half-measures so they can stretch out the period between paying for drugs as long as possible. Not that they’ll randomly decide to quit a course they’ve already paid for.

@2 Alan

“Of course prescription charges only apply in England they have been abolished in Scotland and in Wales2

Yes, darn those pesky Scot Nats and their progressive social democratic vision for a fairer society…… whatever will they think of next? No tuition fees, or free care for the elderly….

…. oh wait…

… if only the English had a party with that kind of vision eh? ;)

This is how the Scots manage to do without NHS prescription charges:

The basic facts are that Scotland accounts for 8.4pc of the UK population, 8.3pc of the UK’s total output and 8.3pc of the UK’s non-oil tax revenues – but 9.2pc of total UK public spending.

Scottish Executive figures for 2009-10 show that spending per capita in Scotland was £11,370, versus £10,320 for the UK. In other words, spending in Scotland was £1,030 – or 10% higher – per head of population than the UK average.
http://www.bbc.co.uk/news/business-16477990

With 90 per cent of prescriptions not subject to charges anyway, why do we retain the other 10 per cent, now raised to the point of obscenity and of positive threat to public health?

Oh, of course, we have to cut David Cameron’s Christmas card list’s income tax somehow. Remember that it is in order to excuse them from that, and in order to save Cameron and Osborne embarrassment at high society weddings and such like, when next you pay for a prescription, or have to go without one because you can no longer afford it.

21. Chrum Rincewind

@17 Chaise Guevara

Thanks for the clarification. However, as David Lindsay @20 points out, some 90% of prescriptions issued in England aren’t subject to charges anyway. So I still find Planeshift’s assertion hard to believe.

the fact that the NHS charges for it at all perhaps questions the essence of the NHS

Ah yes, the essence of the NHS.

That it’s free.

That nobody ever has to pay for it.

That it costs nothing.

Because Bevan struck a Faustian deal to make sure that the NHS will be provided, free of charge, by an irrevocable decree from God and that the usual laws of economics will not apply to healthcare. All costs involved in healing the sick will be paid for with magic money provided by our bountiful creator and his manifestation on earth, the state.

Prescription charges question the above reality and should be abolished.

That’s what you are saying, right?

23. Planeshift

” So I still find Planeshift’s assertion hard to believe.”

Which is a shame as it is not only my assertion, but the assertion of the BMA, virtually every patient organisation including macmillan cancer, the stroke association, asthma uk etc. Its also based on numerous survey evidence about actuial patient behaviour carried out by the above. Below is the link to the report evaulating its impact 3 years on in Wales released a couple of years ago; http://www.wales.nhs.uk/documents/prescriptions-report-three-years.pdf

With regards to the specific assertion;

“A Citizens Advice Bureaux report, prior to the introduction of the policy and
based on evidence gathered between 1999-2001, found that 50 per cent of
clients who had paid prescription charges reported difficulties in affording the
charge and 28 per cent had failed to get all or part of a prescription dispensed
during the previous year because of the cost”

This was supported by virtually every patient group who gave evidence to the assembly health committee at the time as well. Read the report. Like I said earlier, too soon to tell what the long term benefits will be, but the early indications are that the policy will be a positive one. Its why scotland are following suit, and there is massive pressure on England from the sector to copy as well.

24. Chaise Guevara

@ 21

“Thanks for the clarification. However, as David Lindsay @20 points out, some 90% of prescriptions issued in England aren’t subject to charges anyway. So I still find Planeshift’s assertion hard to believe.”

Frankly, I find Lindsay’s assertion hard to believe, and if we’re playing “who’s the most reliable commenter” then Planeshift wins hands down out of the two. As that’s a figure, do we know if there’s a source for it?

As far as I’m concerned, Planeshift’s claim has a high probability of being right based on induction as long as the following is true: “Some people who are not entitled to free prescriptions nevertheless are often tight on cash, to the point where they might have to sacrifice another non-luxury to be able to afford treatment.” I guess that’s the sticking point, and the accuracy or otherwise of the 90% claim would shed some light, at least.

25. Chaise Guevara

@ 22 pagar

“Ah yes, the essence of the NHS.

That it’s free.

That nobody ever has to pay for it.

That it costs nothing.

[...]

That’s what you are saying, right?”

Please either a) point to where Sirena says this or b) withdraw this tired and stupid straw-man attack. It’s getting pretty dull to see the exact same representation of people’s views posted every single time the NHS comes up.

1) If it’s true that only 10% of prescriptions are paid for, you have to wonder just how many people struggle to pay for them. Perhaps a tweak to the exemption rules is all that’s required?

2) The rise is not “drastic” ffs.

3) I don’t get this bit:

“Between then and 2001 the prices rose solidly every year and in that same time frame the number of Britons relying on private healthcare almost trebled.”

Nobody has to rely on private healthcare, and is the suggestion that rising prescription costs are pushing people into the private sector?

27. Planeshift

jack – the exemption criteria needs more than a tweek. try this report for the govt in 2010 : http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/@sta/@perf/documents/digitalasset/dh_116367.pdf

“The list of medical conditions that currently defines exemption is criticised for
being out of date, inconsistent and arbitrary. This list?based approach for defining
exemptions would require periodic review and updating but the list has not been
revised since its introduction in 1968 (with the exception of the recent addition of
cancer) even though patterns of illness and treatment have changed substantially
over the past 40 years.

….. For example, the blanket exemptions for people aged 60 and over means
that many people on relatively high incomes receive an exemption whereas younger people on low incomes are not exempt.”

The report clarrifies the 90% figure – it’s about 60% of the population of england who are exempt, and these people account for 90% of prescriptions.

@ Chaise

point to where Sirena says this

She quotes the BMA saying

“The principle of charging for prescriptions runs counter to the founding principle of an NHS that is free at the point of use”

then says

“the fact that the NHS charges for it at all perhaps questions the essence of the NHS”

She is saying that non payment by the user (that it should be free) is the essence of the NHS.

I do understand that you agree with her but there is no straw man at all……..

29. Chaise Guevara

@ 28 pagar

She quotes the BMA saying

“The principle of charging for prescriptions runs counter to the founding principle of an NHS that is free at the point of use”

then says

“the fact that the NHS charges for it at all perhaps questions the essence of the NHS”

She is saying that non payment by the user (that it should be free) is the essence of the NHS.

I do understand that you agree with her but there is no straw man at all……..”

Oh yes there is. You obviously just don’t know what “free at the point of use” means.

I do understand that you disagree with her but you’re not going to convince anyone by lying about what she said….

I have no evidence for this, but I’d like to bet that a lot of people who are eligible for free prescriptions on income grounds (rather than because they are on specified benefits) don’t realise it. I wonder how many people that would account for.

Further, whilst on principle I’d like prescriptions in England to be free, I wonder if most people realise that an annual certificate costs less than a television licence. Which should matter more to people? Is a couple of quid a week really too much for all the medication you need? I wonder how many people above the threshold for free prescriptions can’t afford that? So I don’t think it’s the cost that’s the problem, it’s the principle.

31. Chaise Guevara

@ 30 David

I concur. I’m still unsure whether or not students, for example, are entitled to seek free prescriptions (the impression I got while at uni was that you could, but you had to fill out an application rather than just ticking the relevant box on the prescription form). So I’m not sure if the “90% of prescriptions are free” above means that they literally are free or that they can be free if the patient realises that they’re entitled.

32. Churm Rincewind

@ 31 chaise guevara – The 90% figure (a slight rise over recent years) refers to the number of prescriptions item dispensed in England. See Planeshift 17. These figures come from the Government, and are not seriously disputed by anyone, despite that fact that you “find it hard to believe” and as result find me an unreliable source.

@ 23 Planeshift – Thank you for referring me to the Welsh Report. However, it does not support your claim. In fact it contradicts it. A key finding of the report was that the abolition of prescription charges in Wales has not affected the number of prescriptions dispensed. It therefore follows that the existence of prescription charges were not previously a disincentive. (Though you wouldn’t know it from the unevidenced spin of the Report’s commentary.)

I’m also not surprised that “virtually every patient group” is opposed to prescription charges. They would be, wouldn’t they?

As for the BMA, the evidence is a great deal more ambiguous that they would like to make out (and let’s remember that the BMA is a lobby group, not a disinterested party.) All OECD countries apply charges for some health services, most commonly for prescription drugs, resulting in some 200 impact studies interestingly summarised in the LSE’s 2008 paper “What Impact Do Prespcription Drug Charges Have On Efficiency and Equity?”.

Certainly the current system in the UK needs overhaul on the margins, and the CAB has done hugely valuable work in this regard. But actual evidence? I don’t think so.

33. Planeshift

@32 – no you’ve clearly misread the report. The graph on page 6 (fig 1) shows the number of items dispensed rises slightly after the abolition of the charge.

The rest of your argument is the usual right wing gibberish of patient groups being vested interests and therefore we can’t believe anything they say. Its the fall back position of somebody who knows he’s been proved wrong.

Could it possibly be that patient groups are motivated by concern for the health of their patients and reporting what patients have told them? Incidentally this isn’t just patient groups making claims on a website, its patient groups giving evidence to assembly (or parliamentary) committees where they provide evidence to back it up – lying to these committees is a big deal.

In what sense do the BMA have an interest in this – you could equally argue they have the interest of wanting their members to deter the hypochondriacs? Are the CAB lying when they publish survey evidence? What about more recently when the English CAB commissioned yougov to do the survey in england and found similar results? Or in the report for the department of health 2010 linked to above where at least 4 peer reviewed papers were cited in support of the assertion that cost deters people from seeking and undertaking treatment (the studies are behind paywalls unfortunately)? Were those peer reviewed studies vested interests as well?

Why is it that the standard right wing response when shown evidence that a policy has a detrimental effect to assume that the victim/advocate of the victim is lying? Whether the issue is rape, racism, disabled people complaining about atos, etc, the default position is that people are lying and making things up. It’s an attitude that needs to stop. If you think the assertion made by a group is wrong, then provide evidence.

34. the a&e charge nurse

Info on prescription exemption charges here
http://www.patient.co.uk/health/Free-or-Reduced-Cost-Prescriptions.htm

The new health and social care bill virtually guarantees that obstacles to charges in other areas of health care will now be rolled back – first in the form of nominal charges for things like ambulance callouts, or GP visits, then, like university tuition fees, a tripling in costs quicker than you can say Tony Blair (or Dave Cameron).

Charges for sexy new drugs offer all sorts of exciting possibilities for the likes of beardy Branson or SERCO.

35. Chaise Guevara

@ 32 Churm

I’m not arguing with the figures now, was just seeking clarification – and when did I say you were an unreliable source?

36. Churm Rincewind

@ Planeshift 33: To recap: I said that the report in question evidences that the abolition of charges in Wales did not lead to an increase in prescriptions dispensed; you say it does. What the report actually says, and I quote, is that there was “no unusual increase following the introduction of the policy (i.e. the abolition of prescription charges) after 2007″. My case rests.

Otherwise you appear to criticise positions I have not taken. It seems to me entirely natural and understandable that individual patient groups would want all treatments relevant to their specific concerns to be provided free by the state. But that is self-interest, not an argument. You refer to evidence, and I’d be grateful if you could provide the appropriate supporting references.

I’m also sceptical of your deference to the BMA’s opinions. The BMA was of course an initial supporter of Lansley’s NHS reforms, provided that their members were financially recompensed for implementing his proposals. I think they acted in self-interest then, and I think they do so now in connection with prescription charges – they see the clinical independence of their members as an over-riding factor.

And, no, I don’t think the CAB is lying. I didn’t say that, and I paid tribute to their work. But there is a considerable disconnect between their evidence and the Welsh survey. How can this be explained? I would tentatively suggest that the CAB surveys gathered patients’ intentions, while the Welsh survey looked at patient behaviour. It’s similar to the difference between surveys of voter intentions and election results. Intentions are speculative; results are final.

You keep saying that the evidence is on your side. Again I would refer you to the report I cited earlier, and I freely admit that its conclusions are complex and don’t fully support my case. But public health provision is a complex issue and is unfortunately not susceptible to an “all possible treatment should be free” approach.

@ Chaise Guevara 35. I apologise if I overstated your position. However, in your post 24 you did seem to suggest that my posts were less reliable.

37. Chaise Guevara

@ Churm

You mean here?

“Frankly, I find Lindsay’s assertion hard to believe, and if we’re playing “who’s the most reliable commenter” then Planeshift wins hands down out of the two.”

Is your name Lindsay? :)

38. Churm Rincewind

@ Chaise Guevara 37: Thanks for this. As your post 24 was addressed to me, I took it that your remark referred to my previous comments. Clearly I misunderstood. My apologies. Again.

39. Chaise Guevara

@ 38 Churm

No worries! For the record, thus far you seem like a sensible commenter and I certainly wouldn’t underweight claims because you made them.


Reactions: Twitter, blogs
  1. Liberal Conspiracy

    Doesn't the drastic rise in prescription charges undermine the NHS? http://t.co/nYxsZc4v

  2. Bob Ellard

    Doesn't the drastic rise in prescription charges undermine the NHS? http://t.co/nYxsZc4v

  3. Jason Brickley

    Doesn’t the drastic rise in prescription charges undermine the NHS? http://t.co/HMSZ47xc

  4. R. Ville

    Doesn't the drastic rise in prescription charges undermine the NHS? http://t.co/nYxsZc4v

  5. susan press

    Doesn't the drastic rise in prescription charges undermine the NHS? http://t.co/nYxsZc4v

  6. Alex Braithwaite

    Doesn't the drastic rise in prescription charges undermine the NHS? http://t.co/nYxsZc4v

  7. leftlinks

    Liberal Conspiracy – Doesn’t the drastic rise in prescription charges undermine the NHS? http://t.co/CZPhUGsk

  8. Molly

    Interesting. RT @libcon Doesn't the drastic rise in prescription charges undermine the NHS? http://t.co/GcbUlYqL

  9. Ben Mitchell

    Doesn’t the drastic rise in prescription charges undermine the NHS? | Liberal Conspiracy http://t.co/mH2Ss8k6 via @libcon

  10. BevR

    Doesn’t the drastic rise in prescription charges undermine the NHS? | Liberal Conspiracy http://t.co/uiqQxIFw via @libcon

  11. Sirena Bergman

    Super interesting comments on my 'Cost of prescriptions' piece for @libcon. Wish I had time to reply to them all! http://t.co/908vN7Hy

  12. IpswichCAB

    Doesn’t the drastic rise in prescription charges undermine the NHS? ~ http://t.co/GL41Woag





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