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Could knowing the price of NHS treatments help patients grasp their true value?

Dr David Turner

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‘OK, so what would you do to improve the NHS then?’

As doctors I’m sure most of us have had this question hurled at us at parties and gatherings with non-medics. It usually takes me off guard and I end up rambling on about the politicians leaving us alone to do our job and not micro managing, which to those not working in the NHS seems a bit vague and woolly.

Recently though a patient showed me the invoice for a relatively minor ophthalmological procedure they’d had performed at a private hospital. Now in addition to answering a question that’s bugged me for years (why do ophthalmologists have such long arms – evidently from carrying their money bags to the bank) this also gave me an idea; how about we start informing NHS patients what their care would have cost?

Supermarkets are in the habit of telling us ‘how much you saved today’ on the bottom of till receipts, so what if we did something similar for healthcare?

We could highlight the cost of in-patient care on discharge summaries

We could start by printing the price of drugs to the NHS on FP10 prescriptions. This would be easy. The scheme could then extend to highlighting the cost of in-patient care on discharge summaries and out-patient visits on the bottom of appointment letters.

Waste in the health service is huge and in part this is due to patients having no idea how much things cost.When prescribing an expensive drug, I often show the patient the cost as it flashes up on the screen and more often than not they are horrified, then thankful they don’t have to pay for it.

Part of the problem with anything that is free at the point of use is it is not valued. A newspaper that costs 20p is more likely to be read than a free one. Humans have pretty basic inbuilt systems for assessing value and worth and one of the reasons there are so many missed appointments at GP surgeries and hospital clinics is they are not valued.

When something is given numerical worth, even a nominal one, it suddenly makes it seem ‘of value’. Take the £1 deposit on supermarket trollies and 5p charge on plastic bags. These are simple ways that assigning a monetary value has changed behaviour radically; trollies get returned and bags reused.

Some will no doubt caution that this would make some patients feel uncomfortable, but I would argue this would be offset by how much we would gain by better educating patients about the true cost of their care.

And let’s not forget if we were in the USA, these would be real invoices not nominal ones.

Dr David Turner is a GP in North West London


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Readers' comments (12)

  • In my experience of informing patients of the costs, most of them become offended that it had been mentioned at all.

    Having worked in Canada in the past, the only thing that will make patients become aware of the cost is if they have to pay upfront for the full cost and then claim most of the money back from the government.

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  • Edoardo Cervoni

    I think that Dr David Turner's idea should not be easily dismissed. Also, Tony's input is a meaningful one.
    Fact is that Primary Care should look at optimisation rather than rationalisation and this cannot be done without a greater patients' involvement. Financial costs and their burden on the ability to deliver good services are real and not just "political battle fields.
    So, yes. I think we should put the idea to a test. Ultimately, what works in Country does not have to necessarily work- somewhere else and vice versa.

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  • It's really difficult to encapsulate what 33 years has taught me about this subject after a while in Australia and study of other countries with insurance schemes. It could take an essay of many pages. I could cite Hume and Kant but I think it would best sum up by saying and not deviating from the point made but , and I am not filling up unnecessary space......but are you joking???? In a system that is free, why should they care???????? Have you lost your mind???? Yes, nurse, I am coming !!!!

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  • Cobblers

    If the patient doesn't have to pay for it themself then it becomes irrelevant. They don't care.

    Using your plastic bag analogy make them pay, at least in part, for their procedure or their consult and then it concentrates minds. Even if they get reimbursed later.

    Free At The Point Of Abuse is one of the problems of the NHS as well as, oddly, its main selling point.

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  • Sadly, David, listing prices would make little difference. The taxpayers won't care, cos 'they pay their taxes'. Those who don't pay tax, are hardly likely to care either. And Cobblers, its hardly a selling point. Its a misrepresentation to say the NHS gives you free treatment. EVERYBODY pays for it, directly as a taxpayer, or indirectly as a result of greater state intervention/spending. If you want patients to 'feel' responsible for healthcare, leave the responsibility of it with them, like in 90% of the rest of the world, i.e. absolute minimum welfare and healthcare provision only.

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  • People need to be aware so why not start putting the cost down in writing so that people can see what they are doing when they reorder their repeat prescription.
    If they have a cupboard full of inhalers then just maybe they won't order another if they realise it costs £20 !

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  • I did this for an article in the Middlesex Hospital Journal in 1967!
    Simply giving staff an indication of what everything cost. It did realign thinking, and might have reduced waste if the idea had been taken up.

    Patients might be concerned to know 'what it costs', yet we tell taxpayers what aircraft carriers cost, and we constantly tell them how much more the NHS could do with.

    'Indicative costings' could be used, not the cost of every item or transaction (which would cost a fortune to administer).

    So: "Please be advised that a standard course of this class of antibiotic costs the NHS around £xxx."; "A joint replacement such as has been recommended for you costs the NHS around £zzz."

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  • I tried this but the unintended consequence was those who paid prescription charges were often very unhappy because their items cost less than a prescription charge.

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  • Not to tell the patient this is the case is surely treating them without having fully informed consent.

    And that is unethical.

    It would then be up to patients to make such representations as they may.

    It is not for doctors to deny them such information.
    For who would we be covering up?

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  • Well, whenever you talk about NHS cost, a group of bureacrats in RCGP and NHS bring the issue of human rights and stop any action of saving NHS and its cost. Don't waste your time and keep calm, carry on.

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