The government’s decision on top-up payments is welcome

One of the commonest complaints about the NHS is: “I’ve paid in all my life, so why can’t I have…” Yet patients still have no power to command a necessarily personal, individual, intimate and timely service.

If everyone held a Health Savings Account for life, no-one would be the victim of the denial policies of the government’s rationing body, the National Institute for Clinical Excellence (NICE), nor of local Primary Care Trust purchasing lotteries. Patients would not have to sell their house to survive cancer by spending the money on special drugs.

We should remember that the NHS is not “free”. It is paid for by compulsory taxation. NICE does not do us a favour by allowing us drugs – neither does a review of policy which lets us top-up. It is our money, taken from us by government. And we live in our own bodies. We live our own lives. It is us who suffer the consequences of any inefficiencies in health services.

The way to enable all individuals to access good care, appropriate treatments and drug therapies – in a fair and equitable system – is to put everyone on the same financial basis. By control of funds they can have control of services.

An Individual Health Savings Account which we each own and control – paid for by the £2,000 per annum each taxpayer contributes now – would give us the choice over what we get. It would accumulate in our lifetime and any savings we made by looking after ourselves better would go towards our elderly care.

The government’s back-tracking on top-up payments is welcome, not least because it will save lives and also allow people to pay voluntarily towards what works. This will build evidence on which treatments should be made more widely available. But without the adoption of Health Savings Accounts it is only a matter of time before the NHS is hit by another funding crisis, when another set of patients struggle with another government quango to try to access services which are taken for granted in insurance-based European healthcare systems.

A small query: Ideally, insurers should not only reimburse costs but be specialised institutional purchasers of health care, in the same way as a mutual fund is a specialised investor. I wouldn’t know which company to invest in and which not, so I let the fund manager do that job. In the same way, I don’t know which doctor is good and which is bad, therefore it would be good to have insurers competing for who picks the best ones. In a pure HSA system there would be no such ‘division of labour’.

Hello Kris,
You make an important point. We need to combine individual HSA’s with a structure of competing purchasers and competing providers. So there would be mutual, co-operative, member-owned purchasers and insurers. I call these Patient Guaranteed Care Associations -acting on behalf of their members, and with doctors and other medical professionals amongst their knowledgable management. Information, outcomes, reputation, cost and access would guide choices. More details in my new IEA book!

Unfortunately an amount accruing at £2k per year doesn’t really help childhood illness.Perhaps all new-borns should get a lump-sum that covers the first 18 years of their life and then starts increasing thereafter.Also a few ethical dilemas regarding severely handicapped children. Without universal cover the argument for euthanasia would get stronger – which may not appeal to everyone.

A small query: Ideally, insurers should not only reimburse costs but be specialised institutional purchasers of health care, in the same way as a mutual fund is a specialised investor. I wouldn’t know which company to invest in and which not, so I let the fund manager do that job. In the same way, I don’t know which doctor is good and which is bad, therefore it would be good to have insurers competing for who picks the best ones. In a pure HSA system there would be no such ‘division of labour’.

Hello Kris,
You make an important point. We need to combine individual HSA’s with a structure of competing purchasers and competing providers. So there would be mutual, co-operative, member-owned purchasers and insurers. I call these Patient Guaranteed Care Associations -acting on behalf of their members, and with doctors and other medical professionals amongst their knowledgable management. Information, outcomes, reputation, cost and access would guide choices. More details in my new IEA book!

Unfortunately an amount accruing at £2k per year doesn’t really help childhood illness.Perhaps all new-borns should get a lump-sum that covers the first 18 years of their life and then starts increasing thereafter.Also a few ethical dilemas regarding severely handicapped children. Without universal cover the argument for euthanasia would get stronger – which may not appeal to everyone.

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