The current prescription charging system could seriously undermine the aims of the government’s new white paper to make healthcare services more accessible to people who need them most, MPs heard last week.
The charges are likely to hinder attempts to make the health service better at helping groups of people who currently find it difficult to get the right health care, such as people in underserved deprived areas, witnesses told the health select committee as part of its continuing inquiry into NHS charges.
Witnesses were asked how the present system of prescription charges affected the policy set out in the Department of Health’s recently published white paper on providing more health care outside hospitals (BMJ 2006;332:253, 4 Feb).
Hamish Meldrum, chairman of the BMA’s General Practitioners Committee, said in giving evidence: “My view is that it probably does &;have an effect&;, in that some of the most hard to reach people and the people you would want to try to attract for treatment are affected by charges and are dissuaded.
“Because we are trying to look at more preventative measures as outlined in the announcements made this week, and we are trying to focus more on that—particularly on underprivileged areas—then I think the present system of prescription charges can only tend to act against that.”
Dr Meldrum referred to prescription charges as a “rather crude tax.” He said, “Apart from the financial contribution, my own view is that probably there’s little evidence of any beneficial contribution to health.”
Another witness, Anthony Harrison, a research fellow at the independent health policy think tank the King’s Fund, said that there was evidence of the effect of prescription charges on the uptake of drugs but that the evidence of the knock&;on effects of this was lacking.
“Those overarching studies just haven’t been done in the UK,” Dr Harrison said. “A few studies have been done simply on the impact of charges over the years, so we can be fairly confident that charges do deter some people, mainly people at the lower end of the income scale. We could do with some more comprehensive, wide ranging studies than we have ever had in this country.”
Although 85&; of prescriptions were exempt from charges, that did not mean that 85&; of people were exempt, said Dr Meldrum. He added that most people who had to pay for prescriptions were at a later stage in their life when a doctor’s intervention could have a big impact on their health.
The present system has many anomalies, which the BMA has often raised with the government.
“Probably every government in the past 30 years has had representations from us. The response tends to be, ‘Well, we know, and we are looking at it and we’ll get back to you.’”
Dr Meldrum said a system in which particular drugs rather than particular conditions were exempt may have some merit. But he added, “Whatever system of exemptions you have, there are bound to be anomalies within it.”
The inquiry continues.