Terminally ill patients to get expensive new drugs on NHS

By Rebecca Smith
Telegraph.co.uk
November 4, 2008
The NHS drugs rationing body the National Institute of health and Clinical Excellence (NICE) will be more flexible in deciding whether drugs for patients at the end of their lives are cost effective.
The move is a victory for campaigners who have argued that it is cruel to deny patients a drug that may extend their lives long enough to see a grandchild born, a daughter’s wedding or the last Christmas with their family.
Currently expensive drugs that prolong life by a few months often breach the cost effective threshold used by Nice.
Some patients want to “top up” their care by paying for these drugs privately only then to be told they forfeit all of their NHS care and must pay for the entirety of their treatment. This is often more than they can afford.
In a fundamental shift in the health service, ministers will announce that patients will now be allowed to buy drugs privately without giving up the right to having the rest of their care paid for by the NHS.
Ministers will admit there will be no financial help for poorer patients who cannot afford to top-up their NHS care.
Critics have said allowing top-ups will create a two-tier NHS and undermine the founding principles that care should be provided irrespective of ability to pay.
http://www.telegraph.co.uk/news/newstopics/politics/health/3374318/Terminally-ill-patients-to-get-expensive-new-drugs-on-NHS.html
And UK’s private insurers move in:
http://www.telegraph.co.uk/finance/personalfinance/insurance/3378442/Victory-for-cancer-patients-as-NHS-ban-on-top-up-drugs-is-lifted.html

There have been many reports from the U.S. opponents of government health programs proclaiming that “life saving drugs are denied” for cancer patients in UK’s NHS. Generally, these are cancer drugs which had been evaluated by the National Institute of Health and Clinical Excellence (NICE) and found to have very little benefit, if any, especially when considering the high prices of these drugs.
The patients could still use the drugs, but they would have to pay for them. Because of the concern that this would create a two-tiered system within the public NHS program, it was decided that patients electing to use these drugs would have to switch to the private sector for their full care. Thus the claim that the government program “denies life saving drugs.”
The decision was reversed when it was decided that individuals obtaining their care through the NHS should not be required to leave the public program merely because, in their desperation, they wanted to be able to purchase expensive drugs of only marginal or questionable benefit.
Most would agree that the public program should cover all beneficial health care services. But should public funds be used to pay for expensive care that provides negligible value, or may even be detrimental? NICE tries to sort these out so that taxpayers are not having to foot the bill for technological and therapeutic excesses that don’t help and may harm.
The private insurance industry in the UK already has been providing supplementary coverage for health care. This coverage duplicates the services of the NHS, but because of higher reimbursement rates allows beneficiaries a greater choice of private care options, and allows them to move into the front of the queue. This has created an explicit two-tiered system in the UK, with underfunding and excessive waiting periods in the public sector. This is precisely why other nations such as Canada prohibit supplementary insurance.
On the other hand, complementary insurance is used to cover health care that is not provided by the public sector, such as drug benefits and foreign travel coverage for Canadians. This decision in the UK to allow non-covered private options for public NHS patients has opened up the market for complementary insurance in the UK, and the insurers are moving in.
The single payer model supported by PNHP would prohibit supplementary insurance, but would allow complementary insurance for services such as hospital suites or non-essential cosmetic surgery that taxpayers should not be required to finance.
The WHO has published an excellent report on private insurance and cost sharing (35 pages): What are the equity, efficiency, cost containment and choice implications of private health-care funding in western Europe?
http://www.euro.who.int/document/e83334.pdf

By Rebecca Smith
Telegraph.co.uk
November 4, 2008

The NHS drugs rationing body the National Institute of health and Clinical Excellence (NICE) will be more flexible in deciding whether drugs for patients at the end of their lives are cost effective.

The move is a victory for campaigners who have argued that it is cruel to deny patients a drug that may extend their lives long enough to see a grandchild born, a daughter’s wedding or the last Christmas with their family.

Currently expensive drugs that prolong life by a few months often breach the cost effective threshold used by Nice.

Some patients want to “top up” their care by paying for these drugs privately only then to be told they forfeit all of their NHS care and must pay for the entirety of their treatment. This is often more than they can afford.

In a fundamental shift in the health service, ministers will announce that patients will now be allowed to buy drugs privately without giving up the right to having the rest of their care paid for by the NHS.

Ministers will admit there will be no financial help for poorer patients who cannot afford to top-up their NHS care.

Critics have said allowing top-ups will create a two-tier NHS and undermine the founding principles that care should be provided irrespective of ability to pay.

http://www.telegraph.co.uk/news/newstopics/politics/health/3374318/Terminally-ill-patients-to-get-expensive-new-drugs-on-NHS.html

And UK’s private insurers move in:
http://www.telegraph.co.uk/finance/personalfinance/insurance/3378442/Victory-for-cancer-patients-as-NHS-ban-on-top-up-drugs-is-lifted.html

Comment:

By Don McCanne, MD

There have been many reports from the U.S. opponents of government health programs proclaiming that “life saving drugs are denied” for cancer patients in UK’s NHS. Generally, these are cancer drugs which had been evaluated by the National Institute of Health and Clinical Excellence (NICE) and found to have very little benefit, if any, especially when considering the high prices of these drugs.

The patients could still use the drugs, but they would have to pay for them. Because of the concern that this would create a two-tiered system within the public NHS program, it was decided that patients electing to use these drugs would have to switch to the private sector for their full care. Thus the claim that the government program “denies life saving drugs.”

The decision was reversed when it was decided that individuals obtaining their care through the NHS should not be required to leave the public program merely because, in their desperation, they wanted to be able to purchase expensive drugs of only marginal or questionable benefit.

Most would agree that the public program should cover all beneficial health care services. But should public funds be used to pay for expensive care that provides negligible value, or may even be detrimental? NICE tries to sort these out so that taxpayers are not having to foot the bill for technological and therapeutic excesses that don’t help and may harm.

The private insurance industry in the UK already has been providing supplementary coverage for health care. This coverage duplicates the services of the NHS, but because of higher reimbursement rates allows beneficiaries a greater choice of private care options, and allows them to move into the front of the queue. This has created an explicit two-tiered system in the UK, with underfunding and excessive waiting periods in the public sector. This is precisely why other nations such as Canada prohibit supplementary insurance.

On the other hand, complementary insurance is used to cover health care that is not provided by the public sector, such as drug benefits and foreign travel coverage for Canadians. This decision in the UK to allow non-covered private options for public NHS patients has opened up the market for complementary insurance in the UK, and the insurers are moving in.

The single payer model supported by PNHP would prohibit supplementary insurance, but would allow complementary insurance for services such as hospital suites or non-essential cosmetic surgery that taxpayers should not be required to finance.

The WHO has published an excellent report on private insurance and cost sharing (35 pages): What are the equity, efficiency, cost containment and choice implications of private health-care funding in western Europe?

http://www.euro.who.int/document/e83334.pdf