Should top-up fees be introduced for NHS patients?

04 Sep 2008

Following recent debates about the NHS’ decision to only fund treatment of cancer and potentially sight-saving anti-VEGF drugs in ‘exceptional circumstances’, the idea of top-up fees has been circulated as a possible solution for funding these expensive drugs.

Recently, the notion that some cancer suffers have been informed that if they opt to fund cancer treating drugs themselves they will surrender their right to all free NHS cancer care, has been heavily publicised.

If top up fees were introduced this would involve the NHS paying the maximum amount that they would be willing to pay for the treatment and the patient themselves funding the remainder.

Critics worry about the response of drug companies to such top-up fees. Currently, they receive incentives to provide such drugs at reasonable prices so that they can get NHS reimbursement. However, should more wealthy individuals be required to only pay the remainder of the fee, this may drive the price of drugs up even if, in doing so, they are likely to incur lower sales volumes.

Additionally, desperate patients may be hopeful that such treatment would provide a miracle cure which might not necessarily be the case. If expectations are high, perhaps drug companies will exploit this weakness, whilst the NHS has refused funding simply because they do not see that the treatment will be effective.

As public awareness of effective new treatments increases and public attention is drawn to the greater explicitness of NHS rationing, it is likely that the issue of top-up fees will continue as an ongoing debate.

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