Should higher earners pay to use the NHS?

Times

7 days ago

A report by the International Monetary Fund has called on the British government to consider charging those on high incomes to use the NHS. The report suggested that in the face of 'tough fiscal choices' facing the chancellor, 'access to public service could depend more on an individual's capacity to pay'. We ask two experts whether this idea could work.
The country can no longer afford to provide healthcare to everyone free at the point of use. It is time for middle and high-earners to start paying.
Nye Bevan's ambition was laudable. However, taxpayer-funded spending on healthcare has reached levels that were unimaginable in the 1940s. It is now the equivalent of the entire GDP of Portugal.
These taxes not only place a heavy burden on households and firms, they also act as a disincentive towards productive activities and dampen economic growth.
In Policy Exchange's report, The NHS — a Suitable Case for Treatment?, we showed that not only is the NHS incredibly expensive, it is also producing far worse outcomes for patients compared with other advanced economies. It ranks second from bottom for healthy life expectancy and preventable and treatable mortality.
We need to make sure that healthcare funding is sustainable while maintaining the principle of universality to ensure that those on modest incomes still get free healthcare.
People with middle and high incomes should start paying for certain services. For example, there should be a £20 fee for a GP appointment, as well as a charge for certain elective procedures.
Free prescriptions and sight and hearing tests for the over-60s should also be abolished. However, all these services should remain free for people on low incomes.
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Of course, we should not adopt the failed US system, which is not only far more expensive but also leaves many people uninsured and with worse outcomes. Instead, the UK should follow the example of most other European countries and shift to a mixed-funding model.
In these countries citizens are required to have health insurance, which is supplemented by co-payments and charges, meaning that wealthier patients who can pay do. Their systems are sustainable, produce better patient outcomes, and ensure that those on low incomes and vulnerable people have access to healthcare.
Such a shift would be radical, but it is necessary. It has the potential to lower costs, reduce the burden on taxpayers, and improve patient outcomes. It is the only way that we can ensure that the NHS is there for us today and in the future.
The British Social Attitudes survey, which has been conducted every year since 1983, makes grim reading for the NHS, but reports of its death are greatly exaggerated.
While only 21 per cent of respondents are satisfied with the way the NHS is run, more than 90 per cent support its central tenet: free at the point of need. People are committed to the principle that everybody, no matter how rich or poor, should have access to treatment, even when dissatisfied with the performance of the NHS.
We want our healthcare system to mirror us as a nation united: the last remnants of Blitz spirit and post-war consensus. I can think of little that would sow the seeds of discontent across our fractured nation faster than implementing a policy that can only bring about a two-tier healthcare system.
Allowing hospitals to charge higher earners is tailor-made for perverse incentives that distort inequalities. Given the present financial crisis, what chief executive would not prioritise the patient who could provide income, even if the clinical need between two patients was equal?
And what would it do to trust in the NHS when patients don't know whether their delayed operation is due to clinical need or the size of their wallet?
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Hospitals in affluent areas already have recruitment advantages. Revenue generation enables investment in staff, equipment, and facilities, leaving the rest to slip even further behind. This ultimately widens the equality gap for those in disadvantaged communities who are most reliant on free healthcare.
Finally, could this be successful? Do we want our cash-strapped NHS to waste resources on hiring marketeers to compete for private demand rather than developing the health prevention messages critical to reducing future costs?
I say this as a great supporter of the NHS. No healthcare system is perfect, but few have principles such as 'free at the point of use' held in such high esteem by its users. It is a principle that many other nations look at with envy.
So, no, the state should not overreach itself by getting richer to pay to use the NHS. Ill-conceived plans like this would sound the death knell for our greatest public institution.