We are back to health care top-ups again - where the Government's position may be known by the time ...
We are back to health care top-ups again - where the Government's position may be known by the time you read this. At the time of writing, comments from Mike Richards, who is carrying out the review, and the National Institute for Clinical Health and Excellence (Nice) both point to a change in the status quo. However, the King's Fund has published its response to the Department of Health's review of the consequences of additional private drugs for NHS care and it is worth examining in detail as it outlines the practical issues that will need to be addressed in the event of change.
The analysis gives two options: 'solidarity' where the Government hardens the current position. The Fund regards this as unsustainable. The second is 'individualist', where people are allowed to purchase care without being penalised through being charged for the NHS element. Assuming the individualist position wins out, the practical issues are: How to calculate the cost of additional care? When is a top-up allowed? The debate has focused on high cost cancer drugs but what about more expensive options for other treatments? Should the cost of the NHS treatment not given be offset against the top-up? What happens if the top-up drug extends life and the individual runs out of money to fund it?
The main 'problem' with individualism remains that some people can afford the top-ups and some cannot. The King's Fund suggests two options. First setting charges based on ability to pay which takes account of assets including estates. But this would mean that public money would be used to subsidise treatments that Nice has not approved just because an individual cannot pay for them. The second suggests charitable funding, as happens with end of life care, but this would retain the lottery element of support.
The Association of British Insurers is seeking a working party with the Department of Health to help deliver insurance based approaches that are 'genuinely affordable by the majority of people'. A seemingly laudable aim, but there is a considerable risk that they will be pressured into guaranteed acceptance of all applicants and underwriting restrictions, for example, on family history of cancer. WPA has been in the driving seat on this debate from an insurance perspective and this shows that individual companies can respond with new products. Why create an insurance market framework where there is no consumer detriment to address and before significant sales in top-ups have actually emerged?
Richard Walsh is managing director of SPPR Consulting.
