How will we pay for the NHS? More taxes? Fees? Donations?
Joe Wright, 18 June 2014
Today’s Times front page carries the story that nurses are in favour of introducing a ten pound charge (£) to see GPs, reporting that they are ‘joining a growing number of voices who say that a cash crisis means desperate measures must be considered. They urged politicians to say how they plan to pay for a health service that faces a £30 billion funding black hole by the end of the decade.’ With an aging population and limited treasury funding there is mounting pressure on the NHS to find the funding it needs. If raising taxes is not an option – and remember the UK spends less than the European average on health care – then there are two options:
One is to do as the nurses say and introduce small fixed fees for use. Their proposal in The Times is a little too blunt as ten pounds will be beyond the means of many, such as the 913,000 people who use food banks. The fee would have to be tapered for low earners and waived for people who cannot afford it. In Ireland people pay comparatively steep fees of 20-50 euros to see the doctor. But there are exemptions and subsidies for students, pensioners and people on low incomes or benefits. In Germany, there’s a 10 euro fee, confined to one payment per quarter, meaning it does not deter multiple visits over short periods of time. Referrals to visit subsequent doctors are excluded from the fee.
NHS fees would face criticisms that ‘charges would deter the poor from seeking help, push people towards A&E and require cumbersome bureaucracy to collect.’ But under these systems, those pressures are surmountable. Fees are not designed to deter low income people, only make people who can pay a nominal fee for extremely costly services.
The biggest hurdle is the principle that the NHS is ‘free at the point of use’. If fees prove too unpalatable to interest groups, and taxation proves a vote loser, then the last option is donations.
This is similar to the second option, only it relies on notoriously unreliable civic duty. Donations could be through a standing order of maybe ten pounds a quarter to the NHS – or more if desired – or the Government could provide the option of paying an extra monthly amount on top of income tax direct to the NHS. There could also be a drive to encourage more people to consider leaving money in their wills – all with a Kitchener-type national drive for funding:
One of two things will happen with this system: either uptake will be good and the NHS will gain some breathing space, or uptake will be poor and we will realise the gulf between our desire for world leading services and our willingness to pay for providing them. Scandinavian-type public services are not possible on US levels of tax. In an organisation the size of the NHS, with the challenges it faces, drastic measures are needed. It is time we pay up, or allow the NHS to find other ways of funding itself.