Letter: The cost of extending prescription charges

Sir: As a student of the pharmaceutical industry, might I draw your readers' attention to the dangers in the Government's proposal to make more people pay for medicines prescribed under the NHS?

British pharmaceutical consumption is already low by international standards. In 1992 medicines accounted for around 10 per cent of NHS spending, a proportion which has hardly changed for the past 30 years. British doctors are cautious about prescribing: the annual number of prescription items per head is about eight, compared with nearly 40 in France. There is no evidence that spending on pharmaceuticals is out of control or that doctors are behaving in an irresponsible manner.

To make all patients pay the current charge of pounds 4.25 would be hard on the old, the poor and the chronically sick, all of whom have lower incomes and greater - often much greater - need for medicines than others. Evidence from the US shows that, faced with high co-payments (the proportion paid by the patient towards the cost of prescriptions), such patients will economise. They will fail to have their prescription dispensed or take a dose lower than their doctor recommends.

Even from the financial standpoint, to extend the scope of co-payments may be a false economy. Where drug therapy is possible it is often the most cost-effective option. If co-payments are imposed on drugs alone, there will be greater use of other - and more expensive - forms of treatment. Once again, there is evidence from other countries that this happens.

Value for money in the NHS will not be achieved by rationing health care according to ability to pay, but by improved efficiency, preventive medicine and a real understanding of the costs/benefits of alternative forms of treatment.

Yours faithfully,

MICHAEL L. BURSTALL

Remit Consultants

London, EC1

21 May