Thoughts on Prescription Charges

Hidden away amongst the discussion of the Compton Review Edwin Poots again mentioned the prospect of reintroducing prescription charges. There is a certain irony in this in that although it was Michael McGimpsey who ended prescription charges the DUP repeatedly claimed this move as one of the successes of devolution and claimed much of the credit for that decision.

More recently, however, Poots has repeatedly proposed reintroducing the charges in order to pay for cancer drugs and the like. Part of the problem of ending prescription charges has been that it proved considerably more expensive than it was at first anticipated (£30 million rather than the expected £13 million). There have been reports of people getting things which seem frivolous on prescription such as sun cream which they should buy for themselves. As an aside there are a number of medical conditions where sun exposure is so dangerous that free sun block might be entirely reasonable such as albinism or lupus. Some drugs such as amiodarone can also make people extremely sun sensitive. However, for the majority of people we should clearly buy our own sun cream.

The concern has been that people have been getting things they previously would not have asked for and either were unnecessary or often would have bought for themselves (such as paracetamol). The current suggestions of a 50p charge seem fairly trivial but may earn some money (the BBC say millions but put no more details on it). They may reduce the trivial requests but the costs of administering a system with only a 50p charge may make the financial benefits negligible and very few over the counter medications cost less than 50p so the reduction in requests for drugs better bought by the patient themselves may be very limited.

There is, however, another possible method for charges.

It must be understood that the prescription charge of £7.40 in England is quite expensive. Sometimes the drugs it buys are vastly dearer: 56 Bosentan tablets – a 28 day supply for a condition called pulmonary hypertension costs £1510.21. On the other hand a 7 day course of amoxicillin (a standard antibiotic) costs £1.07 and a 28 day supply of bendroflumethiazide (for high blood pressure) 79p. Frequently therefore the £7.40 a patient pays is vastly more than the cost of the drugs s/he obtains and more even than could reasonably be considered an acceptable dispensing charge.

The other issue is the cost of prescriptions for long term aliments and who should and should not pay for their prescriptions. From personal experience I have had asthma for 30 years and as an adult always had to pay for my prescriptions (until the charge was abolished). It was noteworthy that pharmacists were sometimes surprised when I got out money to pay for the prescription as they were so used to most people having free prescriptions and “signing on the back”. Currently the DoH in England claim 90% of their prescriptions are free but equally £7.40 per item is so much that it would have to be free for many people: a middle aged man with a heart condition might well still be working and on 5 drugs and, hence, could be charged £37.00 per month (£444 per year). One can, however, obtain a monthly or yearly prepayment (£28.25 and £104 respectively).

Occasionally in the past pharmacists and GPs in England have apparently come to an agreement to help their patients: the GP has issued a private prescription for the medication if it is an inexpensive drug and the pharmacist has then dispensed it for cost price plus a modest dispensing fee. Such a system has required the cooperation of both GP and pharmacist and, I believe, was severely frowned upon by the NHS. It would, however, offer a mechanism for prescription charges which might be fair and equitable and also show patients the cost of their medications. There could be an agreed NHS dispensing charge with at least part of that paid by the patient (say £1.00 or £2.00) and the patient then, in addition, required to pay for the medication up to a maximum value of again £1.00 or £2.00. This would result in patients making a contribution to the cost of their treatment, would discourage obtaining prescriptions for trivial things, would more accurately reflect the true cost of some medications and obtain money for the NI NHS. The introduction of such a system with relatively fewer people qualifying for free prescriptions might offer a mechanism whereby patients could obtain their medications at an acceptable cost whilst saving considerable money for the NHS and possibly even achieve both of these with public acceptance.

, , , ,

  • Crubeen

    Turgon,

    Instead of prescription charges why do we not cease and desist from taking drugs which, in most cases, are not at all necessary and not conducive to good health?

    Very many hospital admissions are iatrogenic in origin – medical treatment has caused the condition that requires hospital admission to treat it. How many years ago was it that doctors in Israel went on strike … and the death rate declined? How many people are put on medication … and more medication to counter side-effects … and more medication etc ad infinitum and how much better off would they be if they never had taken medication in the first place? My mother (RIP) was one of them – eventually had to be taken into hospital to be detoxed. Tough old bird that she was, she defied the prognosis and went home in one piece … but that over-prescription cost her a kidney and nearly terminated her life prematurely.

    Figures – in 1990 -15.9 million prescription items; in 2009 – 33.8 million prescription items. The population in 1990 was 1.6 million; in 2009 it was 1.8 million. Costs – in 1990 -£111.5 million; in 2009 – £416 million. Is it not time that we terminated the “health hustle?”

  • Eglise en bois

    So the “new” cuddly DUP wishes to reintroduce a tax on the sick.

    I can hear the logic already, but why should those who can pay not pay? Well the same could of course be said for water charges, charges that would bring in considerably more than the measely sum suggested in any “administration” tax of the sick.

    Now there is no bravery required in taxing the sick and the elderly – but what about the likes of water charges, would that not be more radical?

    Alternative of course would be to introduce a “list of unaviable products” the lkes of non prescription drugs such as paracetamol, “commercially available” sun creams and toothpastes.

    If there is an abuse of the system with perscriptions for non essential medication then deal with the problem, deal with the GPs who are writting the prescriptions or the pharmacists who are suggesting getting prescriptions for such products.

    taxing the sick is a lazy, cheap and unprincipled way of raising revenue, by politicans that are lazy, cheap and unprincipled.

  • Reader

    Eglise en bois: Alternative of course would be to introduce a “list of unaviable products” the lkes of non prescription drugs such as paracetamol, “commercially available” sun creams and toothpastes
    If doctors are unable to prescribe Paracetamol, then some of them will just prescribe Ibuprofin instead, which isn’t going to help the situation.
    The problem is that stuff that is perceived as free is not valued or conserved. At least some of the prescriptions are for stuff that people would never have bothered with before, and some of the rest is a massive admin overhead on e.g. paracetamol, which is about 2p per tablet if you get it at the right place. I bet it costs the taxpayer a fortune through the prescription service.
    I think that a symbolic charge would prevent some frivolous use of the system. Another improvement – better auditing of eligibility for free prescriptions if part-payment is re-introduced.
    My own household would be hit more than most if prescription charges were re-introduced – my wife would need the annual ‘season ticket’ for her Asthma medicines, and we aren’t elegible for any freebies. Still – there needs to be a practical way to deal with the current waste and inefficiency.
    Eglise en bois: but what about the likes of water charges…
    Same there – people without water meters are more careless with water. But I can’t help wondering if politicians who accidentally stumbled across an efficiency measure while looking to claw back some money, wouldn’t just waste it all on some new populist policy a couple of months down the line.

  • Eglise en bois

    No problem with water meters, bring it on in my view.

    As for the frivolous prescribing, deal with the the errant doctors, why are we scared to do so. if the issue is waste and abuse use the systems we have in place, if medication is life saving or for genuine treatment then it should be free.

    Taxing the sick because we refuse to tackle abuse or because our politicians are too scared to make hard decisions is government by abuse

  • Jack2

    The one good thing the bunch of idiots on the hill have got right and now they want to reverse it.

    Stormont is a huge black hole sucking up cash thats supposed to be used for our benefit.
    EU farming subsidies – completely messed up to the tune of tens of millions.
    Jobs for the boys/girls – convicts on 70k per annum/Double jobbing/Nepotism.
    Transfer tests – another dogs dinner, our future generations education sacrificed on the altar of incompetence. (This is the generation that will eventually have to pay off our debts!)

    Scrap the prescription fee’s for the sick – oh wait hold on a minute…….

  • cynic2

    “Scrap the prescription fee’s for the sick ”

    Great idea. Those who can afford to pay should – and it should be enforced.

  • I agree with cynic2 (what! you say). Those who can afford it should pay a small fee. And no way should over the counter medications be prescibable. I shudder to think the total cost of those should a person visit the doctor to get the prescription.

  • Eglise en bois

    cynic2/joe, so can I assume, you’ll both be joining the “those that can afford it should pay for thier water too campaign!”?

  • I pay for my water directly; it’s metered. So do you, through your rates.

  • Barry the Blender

    I do love the free prescriptions, especially my Omeprazole. My outgoings on Rennies and Ranitidine has significantly declined, thanks to the NHS (although to be honest I would buy it myself if it was over the counter).

  • Alan N/Ards

    I’m with Joe and cynic2 on this one. There should be some sort of small fee for those who can afford it. People who can afford it pay for their dental treatment, eye tests and glasses. I also believe that there are for too many prescriptions given out by GP’s.

    There is a lot of money wasted in hand outs like the cold weather payment. My inlaws get it every year and to be honest they are embarassed to get it. They don’t need it as their collective pensions give them enough money to holiday abroad four times a year. As far as I know there is no way that you can refuse this money. Another man I know spent his on alcohol. It didn’t go on his heating. Another aquaintance used his allowance as his spending money for his holiday in Turkey. The people who need the help should get it but the waste needs to be stopped.

  • Eglise en bois

    You’re all very generous and some of you have been very helpful in identifying abuse and misuse of the current system but deal with that.

    Some have even accepted that revenue can be achieved via water charges but what no one has actually has addressed question of, is payment for treatment – ie charging for medication right within the current framework of the NHS?

    Along with others I agree that over the counter medication should not be free – add them to the list of not to be prescribed. Like others I agree tackle the abuse, particularly at the prescribing level – ie the GP surgeries but there is no argument or justification for taxing the treatment of illness, because if there is, then charging for diagnosis, charging for A&E services, for inpatient care etc etc must equally be justified. To do this fundamentally moves us away from the principle of healthcare being free at point of delivery – you can’t, nor should you, have it both ways.

    Free diagnosis, free emergency interventions and free treatment.

  • Turgon

    Oddly enough despite being the one who started the thread I sort of agree with Eglise en bois. I am not especially fond of the idea of prescription charges but although tackling the problems mentioned above by contributors might help reduce the expense of prescriptions, I am left thinking prescription charges are practically inevitable. If they are it is important to have a more spohisticated system that we used to have and England still has of a flat fee which will no doubt be gradually increased.

  • Eglise en bois

    Turgon, it is only inevitable because the pseudo “walking well” are naive enough to belief it won’t actually affect them, they believe that at a modest charge, they will always be able to afford their treatment and if not then BUPA will pay!

    Where their argue falls apart is that it fails to address the fundamental question, in 2012, with an aging population, where we are able to cure more illnesses – but at greater expense, can we afford to continue to have a free national health service at all?

    Prescription charges are peanuts in this debate, the real debate must be the fiscal policy underpinning healthcare and as a society we are not prepared to have such a mature fundamental discussion. Instead we have infantile policies suggestions from ministers suggesting that raising minuscule amounts of money from those who are ill is both a sensible and caring way to proceed.

    Remember for most of us on this blog we are healthy, generally in employment and relatively comfortable. Genuinely how many of us rely on medications to keep us alive – those with heart conditions, diabetes, CPOD as examples?

    Remember some elderly individuals are on 10+ medications daily, thus the current proposal of 50p per item would be £5 per prescription, all because Minister Poots wants to deal with a problem of inappropriate prescribing! And wishes to reverse one of the “successes” of the last Assembly, this is crazy.

  • Little James

    I agree with Alan N/Ards regarding the fuel allowance, i would love to know the percentage of recipients that actually spend it on fuel. Obviously it benefits some, and indeed it would free up money for pensioners for example. I have seen fellas headinf to the pub with theirs. I suppose the thinking behind it is the “arent we so caring” up on the Hill.