NCPA - National Center for Policy Analysis


June 24, 2008

The United Kingdom's (UK) government-run health care system faces a terrible dilemma: how to balance the freedom of the individual wanting to do everything possible to prolong life against a system which has to set limits on behalf of everyone in order the preserve the principle of free care for all irrespective of their ability to pay, says the Guardian.

Under the current system:

  • The National Health Service (NHS) will withdraw a very sick person's free care merely because they chose to fund an additional element, such as a special drug, of their treatment themselves.
  • Patients are starting to question the rule that patients are either wholly in or wholly out of the NHS.
  • The pressure group Doctors for Reform is planning to mount a legal challenge to this rule.
  • The strength of public feeling has shifted the government's position; although health secretary Alan Johnson initially rejected the idea of top-ups, he has since decided to conduct a ""review" of the current policy surrounding patients who choose to pay for their drugs privately.

There are already some gray areas in the system -- where patients combine NHS-funded and privately-financed care, says the Guardian.  For example:       

  • Patients can buy private rooms and retain NHS treatment.
  • Some go privately for diagnosis before linking back into the NHS (officially not allowed but a reality nevertheless).
  • Many legitimately will seek NHS diagnosis and then go private.

Although many currently believe that allowing top-ups would be a good thing, the UK's publicly funded health system must determine whether it can allow some patients to top up their treatment without seriously damaging the equity of the current system, says the Guardian.

Source: John Appleby, "How To Run A Fair NHS," The Guardian, June 19 2008.

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