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Monday 28th May 2018

Putting a price on life

4th September 2008

Simon Stevens, a CEO with UnitedHealth and trustee of the Kings Fund, picks his way through the top-up payment maze.


The question over whether to allow NHS patients to make "top up" payments to cover treatments the NHS will not fund is destined to be made soon.

Increased public awareness of new treatments and more transparency of NHS rationing has brought this issue to the fore, combined with the National Institute for Health and Clinical Excellence (NICE) indicating that only in exceptional circumstances will treatments costing more than £30,000 a year be recommended for NHS funding.

The think tank Reform and Institute for Public Policy Research argue in principle there is a case for allowing some form of top-up payments.

But there are key considerations:

How will drug companies respond given that they are currently incentivised to hold down prices to get their product rated as "cost-effective" by NICE? With the advent of top-ups, they may opt for higher prices and lower sales.

It is also crucial to manage expectations of patients and protect them from exploitation.

Will those currently opting out of the NHS now expect to have some of their care reimbursed by it?

A fourth considerations is that "too much topping up would reduce public pressure on politicians to ensure high levels of NHS funding for a near-comprehensive core package of healthcare."

There is no clear cut answer to a question the Department of Health has outsourced to cancer czar Mike Richards.

His decision must address all concerns and include public values. Perhaps this is the moment for the NICE citizens' council to play its part.


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