New York Times Examines Practice Of Some Britons To Pay Out-of-Pocket For Care Not Covered By National Health Service

Main Category: Public Health
Article Date: 22 Feb 2008 - 6:00 PDT

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The New York Times on Thursday examined how Britain's National Health Service, which provides all residents with no-cost medical services, has "been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service." Although "hopscotching" between private and public care has been a standard practice among those who can afford it, some recent cases "have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits," the Times reports.

Officials say that allowing people to pay out-of-pocket to "supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones," according to the Times. Britain's Health Secretary Alan Johnson told Parliament that patients "cannot, in one episode of treatment, be treated on the NHS and then allowed, as part of the same episode and the same treatment, to pay money for more drugs," adding, "That way lies the end of the founding principles of the NHS."

However, patients, physicians and officials say the practice occurs regularly -- particularly among people with cancer who "are increasingly likely to demand, and pay for, cutting-edge drugs that the health service considers too expensive to be cost-effective," the Times reports. Karol Sikora, a professor of cancer medicine at the Imperial College School of Medicine who has studied the issue, said, "You have a population that is informed and consumerist about how it behaves about health care information, and an NHS that can no longer afford to pay for everything for everybody" (Lyall, New York Times, 2/21).

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