Consultation on Proposal to abolish NHS Prescription Charges

4 Prescription Charges: Limiting patient demand

4.1 From the outset one of the aims of prescription charging was to limit demand for treatment by putting a price on it. This is fine if people are frivolously demanding drugs that they do not need or which are ineffective in treating their condition (e.g. anti-biotics for a cold). However rises in prescription charges also have the effect of deterring people with genuine medical needs from taking the drugs they need to treat their medical condition(s).

4.2 Five separate UK studies3 have looked at the effect of charging for prescription medicines. All five concluded that increases in prescription charges were associated with decreases in the consumption of the drugs prescribed. Overall the studies suggested that each 10% increase in prescription charges resulted in a 3% decrease in consumption.

4.3 This means simply that as prescription charges become less affordable so more of the people who need the drugs choose not to pay. This can then result in their condition worsening and requiring medical intervention. Thus far from earning the NHS extra revenue prescription charges could end up costing the NHS much more in expensive hospital treatment. The cost of a patient being admitted to and cared for in hospital is over £1,000 a week. If invasive surgery is required the cost rises dramatically.

“Prescription charges deter people from seeking treatment and encourage self-diagnosis, therefore leading to potentially more long term problems. These charges particularly hit hardest, low paid workers” – Jim Devine, UNISON Scotland, Health Organiser

4.4 Neither is this a small problem affecting just a few people. The National Association of Citizens Advice Bureaux carried out research amongst those seeking CABs’ advice. The report based on this research “Unhealthy Charges” (July 2001) concluded that, in England and Wales, as many as 750,000 prescriptions were not dispensed annually because many of the patients could not afford the £6.30 charge associated with the medicines (given our poorer health record that would translate to around 75,000 prescriptions in Scotland). Some 28% of those surveyed reported that they had failed to pay for all, or part, of their prescription due to the cost.

4.5 The NACAB study found that people with medical conditions such as asthma were rationing their medication to keep costs down. In one instance a single mother with glaucoma, who was registered as blind, was informed that she would lose her remaining sight unless she took her prescription eye-drops. But she could neither afford the eight items a month she had been prescribed nor pre-payment certificates. Thus she faced going completely blind.

4.6 In another instance a severly disabled woman with multiple sclerosis who was paying between £30 - £42 a month in charges was told that her income was 15 pence over the limit where she would receive free prescriptions.

“The experience of CAB clients shows that prescription charges can seriously damage your health, and the impact is felt most severely by people on low incomes and with long term health problems” – David Harker, Chief Executive, National Association of CABs

4.7 A similar study by Kidderminster Community Health Council the same year found that 35% of those not eligible for free prescriptions in their area failed to get the chemist to dispense them because of the prohibitive cost.

4.8 These failures to obtain all of the necessary medicines can have important implications for health and the eventual cost to the health service. A study amongst community pharmacy staff in the North of England4 found that a third of items not dispensed were drugs where non-compliance with treatment could adversely affect patient outcomes (e.g corticosteroids, anti-infectives and beta-blockers).

4.9 As well as not having their prescriptions dispensed, or buying over the counter alternatives, patients also took less of their prescribed medicines to make them last longer, selected only certain items, delayed having their prescription dispensed or borrowed money to pay for it.

4.10 For some chronic conditions it is essential that treatment is uninterrupted. Even interrupting or delaying treatment for just a few days can increase the risks to health. For example failure to treat hypertension for relatively brief periods can dramatically increase the risk of stroke (Scotland’s third biggest killer).

4.11 A large scale study in Canada showed that the introduction of a prescription charging scheme led to reduced use of essential drugs. This in turn led to deterioration in patients’ health and extra costs to the health service in terms of visits to accident and emergency departments, acute and long term admission to hospitals and even patients’ death 5. So we can be fairly sure that the current system of prescription charging in the UK also damages some patients health leading to much more expensive hospital stays and in a few cases patients’ premature death.