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Drop the charge

Ami Banerjee
Last edited 10th June 2009
With NHS prescription charges set to rise to £7.20 next month, the British Medical Association called for their abolition (in line with Wales, Scotland and Ireland), describing the current situation as “outdated, iniquitous and detrimental to the health of many patients by acting as a barrier to their taking necessary medication” [1,2]. A BBC poll last year showed that three quarters of adults in the UK also support an end to the charges in England [3]. The one shilling charge on National Health Service (NHS) prescriptions was introduced in1952. It was briefly dropped in 1965, then reintroduced in 1968 at a level of two shillings and six pence and has steadily climbed to the present rate of £7.10. Only 11% of prescriptions currently attract a charge due to exemptions, which include pensioners, children, pregnant women, people on income-related benefits and patients with certain chronic conditions. This number will be further reduced when cancer patients are exempted this year. In the face of the medical profession and the voting public, the government maintains that the charges represent a major annual income of £430 million to the NHS. Although broadening exemption categories may increase access to certain groups, not all patient groups can be reached, and the blanket nature of some exemptions means that some people with high incomes may be exempt while some people with low incomes may not be exempt, e.g. all people over the age of 65. A recent review of 173 studies from 15 high-income countries, including the UK, concluded that prescription charges lowered health status because “they led patients to forego the use of essential drugs, reduced adherence to treatment, and increased the likelihood of needing more intensive care and of dying”, and also lowered equity in the use of health care [4]. The Americans have a euphemism for inadequate access to medicines due to prescription charges: cost-related medication non-adherence or CRN (which translates to “I can’t afford the drugs, doctor”). High-profile media coverage and fierce lobbying have finally resulted in the inclusion of cancer in the exemption categories. Health service provision cannot be planned in this reactive fashion; it must enable medicines to be delivered to all sectors of society in the most efficient, equitable way. Existing data clearly show that prescription charges have a negative health impact and importantly, they are also unlikely to lower total health care expenditure and may in fact increase spending overall [4]. Therefore, even the economic grounds for prescription charges are very shaky, making them untenable if we are to practice evidence-based policy.
  1. NHS charges to rise in England. http://news.bbc.co.uk/1/hi/health/7925167.stm
  2. Department of Health Review - Prescription charges for those with long term conditions - BMA response. http://www.bma.org.uk/health_promotion_ethics/drugs_prescribing/Dohreviewprescharges.jsp?page=1
  3. Call for prescription charge end. http://news.bbc.co.uk/1/hi/health/7488503.stm
  4. Gemmill MC, Thomson S, Mossialos E. What impact do prescription drug charges have on efficiency and equity? Evidence from high-income countries. International Journal for Equity in Health. 2008; 7: 12.

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