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What evidence is there to suggest that the proposal to allow patients to buy drugs not available within the NHS, yet receive any associated supportive care is the start of the process of dismantling the NHS as we know it ie free at the point of delivery.

asked in health care, nhs service

rasputin1309 answers:

None - and also the NHS is not free at the point of delivery - ever visited an NHS dentist? prescriptions? Having to take time off work because doctors surgeries only open when it suits them rather than the patient. Eye tests anyone - hmm they're not free either.

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CGA answers:

The answer is, like Rasputin said, there is no evidence. However, it is worth examining the arguments a little more carefully.

The justice of the case for being able to 'top up' is clear. If someone is prepared and able to pay for drugs that 'MAY' help but have been judged as not cost effective then why should they be penalised by loosing the NHS care they have paid for and would otherwise get. From the point of view of the government/NHS there are also advantages in this. Clearly, they cannot afford to cover the cost of everything and have to make choices. This would take huge pressure to approve marginal treatments off them.

The other side of the argument goes like this :-
- Patients will not be happy being in the next bed to someone getting (better?) treatment that they cannot afford.
- This will lead to the growth of insurance policies to cover the top up costs (maybe defeating the first argument).
- The growth in insurance cover for health care could extend to challenge the government funding of the NHS.

As we already have private health insurance policies around, I do not see any evidence that an extension to these will challenge NHS provision. However, even if it did, I am not sure this would be a bad thing. I live in a country where all health care is insurance based and it is still free at the point of delivery and has enough safety nets to ensure that is is universal. Having lived with both systems I would say that the system here is better managed, fairer to all and works better.

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robinsamuels answers:

As rasputin says, there are plenty of things that the NHS charges for already and it has not been free at the point of delivery for decades.

The NHS was set up to be a separate system from the private medical sector, a patient who could not afford private care could access the NHS, but if they could afford it then they had to choose either totally private or totally NHS. There was no option to pick and mix.

What rasputin doesn't point out though is that most GP's, dentists and opticians are not employed by the NHS. They are private individuals who receive money from the NHS in return for sub-contracting. Believe it or not, there are dentists going out of business because of the lack of funding available and I'm sure that the same applies to doctors and opticians.

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wumpus answers:

No evidence, so far.

But it is a slight concern; if NICE were to decide that they're not going to authorise any drugs which cost more than X, they they're effectively only subsidising treatment rather than paying for it.

And if they continue to reduce X, then they progressively manage to offload a lot of the high-cost treatments onto the patients.
Even if X were to be simply frozen year-on-year, inflation would still reduce its effective worth.

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FillDunil answers:


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