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Letters to the Editor
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Pricing
Recent data fuel cost debate
From Mr M. Stephens, MRPharmS
The letters pages have often included debate on the details and merits
of prescription charges. Recently, Leatherman and Sutherland explored
a wide variety of health related issues, including the impact of costs,
or co-payments, on the way individuals access care.1 The UK is compared
with the US, New Zealand, Australia and Canada. Only 4 per cent of UK
respondents to their survey said that cost caused them to miss a medical
appointment, Canada was the only other country with a figure below 10
per cent. Similarly for avoiding medical tests and even missing dental
visits, the UK had noticeably lower numbers, saying cost had caused them
not to receive care. Additionally, those in the UK on lower income did
not have a much higher incidence of avoiding care due to cost.
However, for the question “do you avoid having a prescription dispensed
or do you skip doses due to cost?”, 45 per cent of UK respondents
said yes. This rose to 55 per cent for those on below average income.
For all respondents, only the US was higher (46 per cent), with New Zealand
the lowest (39 per cent).
A number of issues arise. Access may be impeded due to cost, irrespective
of co-payments. Access to health care in the UK is not greatly disrupted
because of these costs and does well against several reasonable comparators
(note, this is not the same as saying those on lower income are not disadvantaged).
The exception to access being unmarred by cost is with prescribed medicines
where the UK does hardly better than the US; the likelihood of deciding
not to have a prescription dispensed or to miss doses increases noticeably
for those on below average income.
So what? Do we mind that our record on universal access is marred regarding
prescriptions? Is it such a problem that individuals can make choices
not to get a medicine or to “spread out” their doses? It
might. A short-term decision to save money by choosing the antibiotic
not the analgesic following day case surgery could lead to a GP call-out
or a return to A&E. Missing doses or items from a chronic therapy
regimen may mean benefits are lost or that additional hospital admissions
are required. This is the argument explored by Schafheutle in the PJ.2
I am not sure what the best system is, but I do not feel comfortable
with a system that appears to make health care less accessible to those
on lower income. Our aim should be for a system that supports equity
of access without inflating demand. There are features in the current
system that attempt this — “season ticket” and children
exemptions, for example — but the report suggests there is room
for considerable improvement. Pharmacists and pharmaceutical bodies have
an important role to play in assisting policy development in this area.
We can also support the extending the evidence base. These more strategic
public health issues are just as important as the direct to patient advice
and support if we are truly committed to making the most of medicines.
Martin Stephens
Romsey,
Hampshire
References
1. Leatherman S, Sutherland K. The quest for quality in the NHS. Oxford:
Radcliff; 2005.
2. Schafheutle E. Do high prescription charges undermine compliance?
Pharmaceutical Journal 2003;270:336–7 (PDF 45K)
Quarterly changes to Category M
From Dr B. Curwain, MRPharmS
It is not only “wholesalers and pharmacists” who have been
looking for stability from the new regimen of Drug Tariff prices. Primary
care trusts are trying to plan their finances, and to learn that “category
M prices are changed every quarter” (PJ, 9 July, p37), makes that
difficult. We spend around £1.5 m per year on simvastatin, ramipril
and doxazosin, plus a significant amount on the other category M drugs.
Our finance departments are looking for accurate predictions. Perhaps
the Pharmaceutical Services Negotiating Committee should communicate
directly with them to explain the uncertainties of the present situation.
Brian Curwain
New Forest Primary Care Trust
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