Drunks who are abusive to NHS staff should be charged for their treatment, the Liberal Democrats have suggested.
Norman Lamb said NHS decision making should be localised
Health spokesman Norman Lamb said people should face the consequences of their actions - particularly if they were "foul and abusive" to NHS staff.
He also believes pubs should pay if they repeatedly send customers to A&E.
The ideas comes as the party, which gathers in Brighton this weekend for its annual conference, publishes a paper on local NHS services.
The plans include a local health tax offset by cuts in national income tax.
The Lib Dems are also proposing to create a "patient's contract" which will set down the entitlement of all patients, regardless of where they live.
The ideas will be considered by the Lib Dems' health policy working group.
'Voices not heard'
Addressing the issue of violent patients Mr Lamb said there was a case for arguing they should be financially penalised.
He said: "If you go out on a Friday or a Saturday night and get very drunk and you end up in accident and emergency, and you are foul and abusive to staff who are already overstretched, then is it right that you should get that care entirely for free, or are there consequences to your actions? "And I think there is a case for saying that someone in those circumstances should be asked to pay for their care."
He said decisions should be taken at local level, by locally-elected health boards, because different areas had different health priorities.
"In today's highly centralised NHS there is a real 'democratic deficit', with too many decisions made in Whitehall," he said.
"Protests against hospital closures and cuts to services, up and down the country, show that local people do not feel their voices are being heard.
"Liberal Democrats think the status quo is unacceptable. The key is creating real accountability to local communities, where they have the power to make decisions on how money is spent on their NHS."
A spokeswoman for the Department of Health said: "We are already devolving decision-making so that the NHS responds to the needs and wants of the public, making ministers increasingly accountable for what the NHS provides, rather than how it is provided.
"More and more, our emphasis is on putting power into the hands of patients and staff, to use the increased investment and reforms to deliver a real transformation in the quality of health and health care."