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Is it time to introduce user charges for NHS cancer patients?

An NHS cancer specialist researching fiscal sustainability of health care systems at the London School of Economics and Political Science (LSE) has outlined in a new research paper published in the latest edition of the Journal of Cancer Policy, the potential role for charging cancer patients for some treatments to ensure the continuation of high quality care within stagnating NHS budgets.

Dr Ajay Aggarwal, argues in the paper, co-authored with Professor Richard Sullivan, Director of The Institute of Cancer Policy at King’s College London, that “user charges could provide a potential means of sustaining spending proportional to the projected rise in the number of cancer cases, whilst embracing technological innovations which could potentially improve outcomes.”Dr

Dr Aggarwal and Professor Sullivan add that “budgets are tightly constrained and health technology assessments designed to ensure coverage of high value interventions have come under significant public and political scrutiny.” Charges for certain treatments, they explain, “potentially provide a framework to ‘nudge’ patients from low value care of limited effectiveness towards high value cost effective treatment, thereby increasing overall efficiency. Without such charges, there could be “potential rationing of high value treatments” they conclude.

The research says that there is not enough radiotherapy capacity to meet demand in the U.K; by 2016 there will be a requirement for an extra 147 radiotherapy machines. Given the current financial restrictions in place this is unlikely to be achieved as each machine typically costs £1.4 million, a figure which excludes the necessary staffing, training, software and quality assurance outlay.

The cost of providing cancer drugs is also increasing dramatically, according to the research, and there is widespread public and professional discontent at attempts by NICE (National Institute for Health and Care Excellence) to control the provision of drugs which are not deemed cost effective, irrespective of the transparency and detailed methodology of current health technology assessments by NICE.  The paper says: “These difficulties are exacerbated when the same drugs that have been refused in the UK are widely available in the US and Europe,”

The research concludes that people are already paying for dental and optical treatment, as well as prescriptions, and that all NHS services could include some form of payment, exempting people on low incomes, the elderly, children and those with certain medical conditions. Equally important are supply side controls with greater focus on physician test ordering, and improving the quality of doctor-patient communication, especially when discussing treatment options towards the end of life ensuring appropriate use of resources.

Dr Aggarwal commented: “New approaches to paying for cancer care need to be found…Cancer is too personal and emotive for the public to accept decisions on restricting access to cancer treatments. Despite being a radical departure from current public policy discourse on affordable cancer care, user charges could provide the key to long term sustainability of high quality cancer care in the UK.”

Professor Sullivan commented: “This is an important and challenging area for cancer care in the NHS. We need to try out a range of different models for delivering an affordable cancer care system”. 


Dr Ajay Aggarwal is unavailable for further comment due to professional commitments. He undertook this research during a masters degree at LSE's department of social policy which he has now completed.

To interview Professor Sullivan, please contact him on 07720 398401

For a copy of the report, please email j.m.bale@lse.ac.uk

6 February 2014