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Tuesday, 6 July, 1999, 08:01 GMT 09:01 UK
'Why patients should pay'
Dr Jonathan Reggler
Dr Jonathan Reggler proposed a 10 fee to see a GP
Dr Jonathan Reggler unsuccessfully asked the British Medical Association to back the introduction of a 10 fee for patients to see their GP. It is a controversial idea, but one that Dr Reggler told BBC News Online is necessary to save the NHS.

"It may seem incredible that a GP is calling for the introduction of patient charges. However, the NHS faces two very serious problems and patient charges would be an important part of rescuing the NHS.

Firstly, the NHS has been underfunded since its foundation 50 years ago but the problem is worsening because medical advances are producing a so-called medical inflation rate which is much greater than the general inflation rate.

Secondly, there has been a dramatic increase in the demands which are being placed on the NHS. As one example patients are attending their GP's surgeries much more often than they used.

This is not because we are all more ill. About 70% of all consultations are for minor conditions that would improve within three or four days.

Unfortunately, patients increasingly see their GP on the first or second day of these minor illnesses. Demands like this are stretching the NHS to breaking point.

Patient charges for seeing a GP or attending casualty would make people ask the question "Do I really need to see a doctor?"

Under the current sytem it is a question which patients don't ask themselves often enough.

10 charge is reasonable

A charge of 10 - less than the cost of a hamburger meal for a family of four - would be a reasonable charge.

There should also be a fee to attend out-patients. For patients staying in hospital there should be charges for food and the "hotel" elements of their stay.

This is already the case for pensioners, who lose some of their pension wen they have been in hospital for longer than a set period.

Continental countries like Sweden pay for most of their health service through taxation or compulsory insurance (which amounts to much the same thing) but most make patients pay a user fee.

There is no evidence - none at all - that user fees prevent patients in devloped countries from seeing a doctor.

Charges do not harm patients. They do, however, reduce inappropriate demand on the service and thus protect it.

Clearly the poor would need to be exempt from patient charges - as they are in Europe.

The chronically ill should also be protected by a maximum annual fee payable by each person.

UK cannot afford a comprehensive, free NHS

The main argument against user fees is that a nation such as the UK should provide a comprehensive and free-at-the-point-of-use health service and that it can afford to do so.

Unfortunately, as the NHS is already on its knees, this would take a considerable increase in taxation (or a cut in other services such as education).

This does not seem to be something which any political party can propose and still hope to be elected. The Labour Party learned this in 1992.

When asked in the street if they favour increased taxation to pay for the NHS most voters say yes.

When asked the same question in the ballot booth the voters' answer is different.

I believe patient charges are inevitable. The sooner they are introduced the sooner we can start the process of arresting the decline in the state of the NHS.

Patient charges are not the only answer, but they are part of the answer."

See also:

05 Jul 99 | Health
Doctors reject patient charges
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