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Tuesday, July 24, 2007

The cost of free prescriptions

This morning's Western Mail tells us that there is considerable unease on the part of some GPs and medical charities about the impact of free prescriptions, introduced in Wales as of 1 April this year.

The paper reports on anecdotal evidence that patients are already bombarding their GP surgeries with demands for cheap over-the-counter medicines free on prescription. They say that demands include prescriptions for paracetamol, which can cost as little as 1p a pill.

They also suggest there is increasing concern that patients with genuine medical problems are struggling to get appointments with their doctors in an already under-pressure system as people seek to save a few pounds on medicines.

Dr Ashok Rayani, a GP in Swansea, said, “We have seen many more patients coming to the surgery asking for hayfever treatments, paracetamol and ibuprofen.

“When we recommend that they go to their pharmacist, they say why can’t they have a prescription.

“It’s not just the GPs who are under pressure – the nurses are under pressure and other patients, with more health needs or with chronic illnesses, are not able to get appointments to see their doctor for more serious problems.”

The director of Bowel Cancer Wales, Nick Phillips, makes an excellent point when he highlights the inequity of ground-breaking and expensive anti-cancer drugs being denied to patients on the NHS on the grounds of costs, while everyone gets free prescriptions regardless of their means. He asks why should a multi-millionaire have the right to free prescriptions?

Welsh Liberal Democrat Health Spokesperson, Jenny Randerson, agrees: “The 20% of people who were paying for prescription should, in my view, continue paying for them. At the same time we should also be sorting out a much longer list of chronic conditions, which would be eligible for free prescriptions. We have a financially over-stretched health service and this [free prescriptions] is an expensive option.”
Is it really likely that the 20% of people who used to pay for prescriptions (presumably the wealthiest) would waste their valuable time seeing a doctor in order to avoid shelling out a few pence for asprins? Sure. I can just see all those well paid lawyers, business people, managers and civil servants clogging up the waiting rooms. The Western Mail needs to get out more and not rush to print with made-up scare-stories supplied by charity and drug company lobbyists.
why should the 'well-off' 20% get free prescriptions? well, it's simple - they pay their taxes and should be treated just the same as anyone else. In fact, they PAY for everyone else too!

Honestly now, why should those who are doing well be treated as second class citizens? It's an odd sort of prejudice, and one I'd have thought liberals would be over by now.
If we had unlimited resources then I would agree with you but we do not. The funding of the health service is clearly about the distribution of scarce resources in the most effective way. In such a situation it is only reasonable that those who are better off should make a small contribution to the cost of their prescriptions especially when such a measure helps to relieve pressure on other NHS resources such as doctor's time.
This is an obvious outcome. You move from rationing by price (people will pay if they need them, but otherwise they won't bother) to rationing by time (wasting of doctor's time and increased waiting lists). Perhaps there's a lesson for the NHS as a whole?

Prescriptions should not be free except for those who are very poor.

There is a case for those who need very long periods on a drug to have free, or reduced prescriptions (I'm on long term drugs but don't really mind paying, but I'm well off enough, sometimes a pre-payment certificate does save me money though).
"Haven't we been here before"? I recall my elderly relatives talking about a period when prescriptions were free and this caused so many problems that the government brought in fixed prescription charges, but which were waived for folks on minimum incomes, on benefits etc. Seems like history is repeating itself. *Ponders why*
There's really an issue of transparency here - is it acceptable, if you pay your NI Conts, for your to see your entitlement to NHS services eroded bit by bit? I'm not sure that it is, and I suppose that's where my unease at making the 'better off' pay for everyone else, pay for the services they've been excluded from on income grounds and then pay for services they need comes from.

Rather than this skewed redistribution, why not just raise taxes or NICs?
The Cardiff Local Health Board was citing (on Radio Wales today) the cost of prescribing Herceptin as a primary reason for not funding Phase II of the National Children's Hospital.
- Frank Little
If the "well off" are to pay, how is that payment to be calculated?

Do we pay on a sliding scale depending on our means? Or does everyone pay if they earn above a certain income - some arbitrary threshold. Not everybody who had to pay prior to abolition of charges was "well off".

Would that not mean rolling back the system even further than pre-abolition days. Wouldn't it mean that a many under-25s and over 60s would now have to pay. People of pension age have had free prescriptions as long as I can remember (admittedly I'm a young-ish pup!). And if that's the case then why should "well off" women get free prescriptions because they're pregnant, or the children of "well off" parents get prescriptions free just because they're children. You could end up with MORE people paying (which may be what you're after) but you'd have to set up a whole bureaucracy just to assess people's means.
The previous arrangement where about 20% of the population paid would be about right with two exceptions:

1. More exemptions for people with long term illnesses; and
2. A lower rate than in England, possibly two or three pounds.
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