Chris Lancelot on... A mix of public and private

The NHS was set up to deliver healthcare to everyone, free at the point of delivery, and paid for through general taxation. Yet anyone using private healthcare is immediately excluded from these benefits.

This is immoral. If someone chooses to go privately, why should the NHS wash its hands of all responsibility? The patient has already paid for their treatment through their taxes: why should they have to fork out again? Why should they pay for the entire cost of their private prescriptions, especially where these would be identical under the NHS?

Clearly the NHS cannot be expected to pay for the extra benefits offered by the private sector, especially over accommodation and the timing of treatment. One solution would be to introduce a voucher system covering individual items of patient care. A voucher for a specific procedure could either be exchanged for 'free' care in an NHS setting or else used in payment (or part-payment) of the bill for private treatment.

The advantages of such a system are enormous. It is ethical: no one pays twice. Patients desiring the extra benefits of private care would obtain them at relatively small additional cost - the ability to select a particular hospital; to be treated at a particular time or date, or by a specific doctor. This is real choice, and the top-up fees (now small by comparison with the previous cost of the entire treatment) would make private care affordable to a much larger section of society. Top-up fees could also apply in primary care - for example, allowing GPs to charge a premium for evening and weekend commuter surgeries.

Although total NHS costs would initially have to rise to finance treatment formerly paid for privately, there are hidden future financial benefits for the NHS. Demand for healthcare far outstrips supply, so there is no true competition. But under a voucher system the private sector could expand to meet the extra demand, while still competing on a level playing field with all other suppliers. By encouraging true competition, a voucher system would ultimately drive down costs, improve quality and availability, satisfy ordinary patients' desires cheaply, and above all be moral and ethical.

Currently none of the major political parties is recommending a voucher scheme, which is a pity. It is high time it was tried: under a voucher system everyone benefits.

Dr Lancelot is a GP from Lancashire.

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