Rethinking primary care user fees: is charging a fee for appointments a solution to NHS underfunding?
Rethinking primary care user fees: is charging a fee for appointments a solution to NHS underfunding?
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重新思考初级保健用户费用：收取预约费用是否是 NHS 资金不足的解决方案？
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
A. Majeed
中科院分区：
文献类型：
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作者：
G. Greenfield;B. Majeed;B. Hayhoe;S. Rawaf;A. Majeed
初级保健预约收费能否减轻卫生服务的资金压力和初级保健工作量？这篇社论审查了其他高收入国家在初级保健使用者收费的预期和非预期后果方面吸取的教训。
在国民健康保险制度中，关于用户收费的争论并不新鲜。1951年，当时的财政部长休·盖茨凯尔在国民健康保险制度中引入了对处方、眼镜和假牙的收费。劳工部长兼国民健康保险制度的设计者阿奈林·贝万辞职，以抗议这种对在需要时不受照顾的原则的放弃。
67年后，在NHS成立70周年之际，关于用户费用的辩论比以往任何时候都更加及时。2016年，英格兰的NHS出现了其历史上最大的总赤字，达到18.5亿GB，预计到2020年将有300亿GB的资金缺口。预计从2015年至2016年到20211至2020年，资本支出将实际减少9%，预计到2020年将降至国内生产总值的6.8%，2这将使英国成为经济合作与发展组织(OECD)国家中最低的四分之一。对NHS初级保健的需求继续增加，英格兰的全科医生现在比10年前更忙。供需之间日益严重的不匹配引发了人们的担忧，即从摇篮到坟墓免费的历史概念是否仍可实现。首相在6月份表示的额外200亿GB是一项关键的援助，但需要可持续的解决方案来确保NHS长期供需平衡。
一个建议的解决方案是引入初级保健服务的使用费。许多高度发达的国家向用户收取获得初级保健的费用，通常是通过统一费率的共同付费。改革智库建议对初级保健预约收取10 GB的费用，这可能会…
Could a fee for primary care appointments alleviate health services funding pressures and primary care workload? This editorial examines the lessons learnt in other high-income countries regarding intended and unintended consequences of primary care user charges.
Debates over user fees in the NHS are not new. In 1951, Hugh Gaitskell, then Minister of Treasury, introduced charges for prescriptions, spectacles, and dentures in the NHS. Aneurin Bevan, Minister for Labour and architect of the NHS, resigned in protest at this abandonment of the principle of care free at the point of need.
Sixty-seven years later, on the 70th anniversary of the NHS, the debate on user fees is timelier than ever. In 2016, the NHS in England saw the largest aggregate deficit in its history, at £1.85 billion, with a projected £30 billion funding gap by 2020. Capital spending is projected to be reduced by 9% in real terms from 2015–2016 to 2020–20211 and is projected to fall to 6.8% of GDP by 2020,2 putting the UK in the lowest quartile among Organisation for Economic Co-operation and Development (OECD) countries. Demand for NHS primary care continues to increase, and GPs in England are now busier than 10 years ago. The growing mismatch between supply and demand raises concerns whether the historical concept of a free cradle-to-grave NHS is still achievable. The additional £20 billion indicated by the prime minister in June is a critical aid, yet sustainable solutions are needed to ensure the NHS balances supply and demand in the long term.
One proposed solution is introduction of user fees for primary care services. Many highly developed countries charge users to access primary care, commonly through a flat-rate co-payment. The Reform think-tank has suggested a £10 fee for primary care appointments, which could …
影响因子：
158.5
作者：
Hsu, John;Price, Mary;Selby, Joseph V.
通讯作者：
Selby, Joseph V.