The current economic climate is leading to calls for expanding the role of user charges. Although there is mounting evidence that this would lead to reduced access for those most in need in most cases, current evaluations of a valued based orientation in health system design suggests that, in some circumstances, both cost savings and health gains could be achieved.
A value based system could include abolishing any user charges for high value health care interventions, keeping them unchanged for those of moderate value and increasing them for those of low value. In a simulation study with US data, researchers have observed that such a system might increase population health gains (as measured in life years) by between 0.6% and 9.4%, depending on how broadly the system was implemented, and, significantly, without increasing costs and without increasing overall out-of-pocket payments.
It is not clear, however, what would be the role of such an approach in the NHS. Certain characteristics of the NHS, such as the strong primary care focus and the gatekeeping system, do already deliver the expected benefits of a value based design. Based on this argument, resaerchers at LSE Health and the European Observatory of Health Systems and Polocies have recently advocated in this respect the complete abolition of user charges.
Further information:
On value based health systems design: Chernew M et al. Health Affairs 2007 link
On the simulation study: Braithwaite R et al. PLoS Medicine 2010 link
On the implications for the UK and the NHS: Thomspson S et al. BMJ 2010 link
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