England is fast becoming the UK's last bastion of prescription charging. Fees for scrips rose again in England this week, while in Scotland they were cut, following a similar move in Northern Ireland in January.
From 2010, Northern Ireland will copy the Welsh system by abolishing the charges altogether. A year later, Scotland will follow suit.
The DoH in England has made concessions. It abolished charges for cancer patients and plans to do the same for patients with long-term conditions.
Ministers have insisted charges are here to stay, but Labour MP for Bristol North West Doug Naysmith, a member of the House of Commons health select committee, suggested Labour may scrap fees in its manifesto.
Speaking at a debate on prescription exemptions, Mr Naysmith said that the fear that abolition would cost too much was the primary political motivation for retaining charges.
He said that, although he did not know the details of current government plans, 'it would be something for the manifesto that would stand out'.
According to DoH figures, the prescription charge system costs £50 million a year to administer and generates a net profit of £400 million.
However, the administration figure does not include indirect costs, such as GPs' and pharmacists' time spent discussing charges with patients. The £450 million income must also be offset against additional and unnecessary healthcare costs.
International evidence shows that deterring people from obtaining medicines they need gives rise to costs elsewhere in the healthcare system. These include preventable hospital admissions, according to Eileen Neilson, head of policy development at the Royal Pharmaceutical Society.
Although these costs are hard to estimate, more evidence will be available later this year. The impact of removing prescription charges in Wales on the use of health services, and on health outcomes, has been studied by researchers at the University of Glamorgan, with findings due to be published soon.
Mr Naysmith added that changes to exemptions will have a significant impact on prescription charge income.
Gordon Brown announced last year that prescription charges would be scrapped for patients with cancer. He also said that exemption would be extended to people with long-term conditions.
The DoH believes that extending exemption to cancer patients will cost around £16 million a year. Rough estimates by the BMA suggest that far greater income reductions will result from scrapping fees for long-term condition patients.
This would cost around £37 million for antihypertensives, £24 million for antidepressants and £11 million for inhaled corticosteroids, the BMA says.
Increasing exemptions will also increase administrative costs, further denting income.
Mr Naysmith said the total cost of scrapping prescription fees was 'peanuts' compared with the money being used to bail out failing banks.
He added that while the financial argument for retaining charges had weakened, other arguments were crumbling too. 'The argument that everyone will be bothering primary care providers used to be quite powerful, I don't know that it still is.'
Experience from the abolition of charges in Wales had not borne out such concerns, Ms Neilson said. 'In the most recent year that there is data on, the number of prescriptions was rising more slowly in Wales than in England.'
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